Lymphocytes – ABC CARDIOL

IJCS

Review Article

Inflammation in Cardiovascular Disease: Current Status and Future Perspectives

Francisco Antonio Helfenstein Fonseca et al. Maria Cristina Izar

Abstract

Atherosclerosis has been defined as an inflammatory disease. Three decades of research have pointed to a pivotal role of interleukin 6 for many aspects of cardiovascular disease, not the least of which is atherosclerosis. In this review, experimental and clinical studies are reported on a timeline, exploring mechanisms and possible explanations that form the basis of current knowledge. Some successful clinical trials were proof of concept studies, showing that not only inflammatory biomarkers are related to cardiovascular outcomes, but also that decreasing inflammation can reduce cardiovascular events. Great advances have been made in the management of residual cardiovascular risk due to cholesterol, thrombosis, and metabolic diseases, but the next frontier now seems to be targeting inflammation. In the upcoming years, the importance of inflammation will be evaluated in high-risk patients with chronic kidney disease, after acute coronary heart disease or heart failure with preserved ejection fraction. Inflammation seems to precede the development of cardiovascular risk factors. Moreover, counseling for a heathy lifestyle and, when necessary, the use of cardiometabolic therapies capable of decreasing inflammation, might be important.

Read Full Article

ABC

Original Article

Pharmacoinvasive Strategy in Elderly Up to 75 Years or Non-Elderly: Analysis of Biochemical and Cardiac Magnetic Resonance Imaging Parameters

Amanda S. Bacchin et al. Francisco A. H. Fonseca Rui Povoa Gilberto Szarf … Ibraim Masciarelli Pinto Adriano Mendes Caixeta Daniela Teixeira Ieda Longo Maugeri Mayari E. Ishimura Maria E. R. Coste Henrique Tria Bianco Carolina N. França Maria Cristina Izar

Abstract

Background

Pharmacoinvasive strategy is an alternative when primary percutaneous coronary intervention (PCI) is not feasible.

Objectives

This study aimed to evaluate the effects of early pharmacoinvasive strategy on the infarct size and left ventricular ejection fraction in elderly and non-elderly patients. The role of inflammatory markers was also examined.

Methods

Patients (n=223) with ST segment elevation myocardial infarction (STEMI) were prospectively included and submitted to pharmacological thrombolysis in the first six hours, and underwent coronary angiogram and PCI when necessary, in the first 24 hours. Blood samples were collected in the first day (D1) and after 30 days (D30). Cardiac magnetic resonance imaging (cMRI) was performed at D30. Significance was set at p<0.05.

Results

Elderly and non-elderly patients showed similar percentage of infarcted mass (13.7 [6.9-17.0] vs. 14.0 [7.3-26.0], respectively, p=0.13) (median [interquartile range]). However, elderly patients had better left ventricular ejection fraction (53 [45-62] vs. 49 [39-58], p=0.025). Titers of interleukin (IL)1beta, IL-4, IL-6, and IL-10 did not differ between D1 and D30, but elderly patients had higher titers for IL-18 at D1 and D30. Absolute numbers of B and T lymphocytes were similar in both groups at D1 and D30, but elderly patients had higher neutrophil/lymphocyte ratio at D30. Multivariate linear regression analysis of cMRI outcomes in the whole population showed that the independent predictors were not different between elderly and non-elderly patients.

Conclusion

Pharmacoinvasive strategy in elderly patients was associated with small differences in inflammatory parameters, similar infarct size and better left ventricular function than non-elderly patients.

Read Full Article

ABC

Letter to the Editor

Analysis of the Neutrophil-Lymphocyte Ratio as a Marker of Atherosclerosis of the Abdominal Aorta

João Victor Domiciano Martins et al. Rodrigo Mendes Johnnatas Mikael Lopes Pedro Pereira Tenório

Dear Editor,

We read with great interest the article: Neutrophil-Lymphocyte Ratio and Abdominal Aortic Atherosclerosis among Asymptomatic Individuals, which evaluated whether the neutrophil-lymphocyte ratio (NRL) could be associated with abdominal aortic atherosclerosis (AtAA). A positive association between the increase in NLR and AtAA was demonstrated when comparing carriers and non-carriers of the disease. However, when adjusting the statistical analysis for age and risk factors, this association did not remain true.

[…]

Read Full Article

ABC

Original Article

Neutrophil-To-Lymphocyte Ratio and Abdominal Aortic Atherosclerosis among Asymptomatic Individuals

Bárbara Said Marin et al. Fernando Cesena Antonio Gabriele Laurinavicius Raul D. Santos Marcio Sommer Bittencourt

Abstract

Background

Neutrophil-to-lymphocyte ratio (NLR) has been proposed as an inflammatory marker that might be associated with coronary atherosclerosis, although most of the current data is restricted to the acute setting. Additionally, the association of NLR with extracoronary atherosclerosis and stable disease remains unclear.

Objective

To analyze the association between NLR and abdominal aortic atherosclerosis (AAAt).

Methods

We included asymptomatic individuals who underwent a health screening program. AAAt was measured by ultrasound. Absolute leukocyte and lymphocyte counts were used to calculate the NLR. The level of significance for statistical analysis was 0.05.

Results

Among 36,985 individuals (age: 42±10 years, 72% male), AAAt was identified in 7%. Those with AAAt were older and more likely to be male and diabetic. Presence of AAAt was associated with increased NLR (odds ratio [OR] 1.17; 95% confidence interval [CI] 1.13-1.21). However, this association was no longer significant when the analysis was adjusted for risk factors (OR 1.02; 95% CI 0.97-1.06), mostly due to the inclusion of age in the model. When neutrophils and lymphocytes were analyzed separately, the negative association between lymphocytes and AAAt was inverted once age was accounted for, suggesting a strong confounding effect of age on the relationship between lymphocytes and atherosclerosis. Finally, the association of neutrophils and AAAt lost significance after an additional adjustment for traditional risk factors, but not age alone.

Conclusion

Although the NLR was associated with AAAt, this was largely due to the confounding effect of age. Overall, the results suggest a limited role of leukocyte measurements as biomarkers of AAAt.

Read Full Article

ABC

Letter to the Editor

Neutrophil-to-Lymphocyte Ratio, Platelet-to-Lymphocyte Ratio and Heart Failure

Viroj Wiwanitkit

[…]

Read Full Article

ABC

Artigo Original

An assessment of neutrophils/lymphocytes ratio in patients suspected of acute coronary syndrome

Ana Denise Zazula et al. Daniel Précoma-Neto Aline Maria Gomes Heidi Kruklis … Giovano Franco Barbieri Rafael Yared Forte André Ribeiro Langowiski Giuseppe Facin Luiz Cesar Guarita de Souza José Rocha Faria Neto

BACKGROUND: Leukocytes total count is an independent risk marker for cardiovascular events. The ratio between neutrophils and lymphocytes (N/L) count has been investigated as a new predictor for cardiovascular risk, although its diagnostic role when assessing patients suspected of an acute coronary syndrome (ACS) condition is not yet known. OBJECTIVE: To evaluate the diagnostic power of N/L ratio in patients who have been admitted at a Chest Pain Unit (CPU) with the suspicion of ACS. METHODS: Evaluation was conducted in 178 patients admitted with chest pain. Diagnostic flowchart including clinical, electrocardiographic, and laboratory data. Diagnosis obtained was: acute myocardial infarction (AMI) with (AMI-STE) and with no segment T elevation (AMI-NSTE), unstable angina (UA ) and non-cardiac pain (NC). Total and differential leukocyte count was conducted in peripheral blood sample collected at admission. RESULTS: Patients diagnosed with non-cardiac pain reported the lowest N/L ratio (n=45; 3.0 ± 1.6), followed by UA (n=65; 3.6 ± 2.9), AMI-NSTE (n=33; 4.8 ± 3.7) and AMI-STE (n=35; 6.9 ± 5.7); p < 0.0001. N/L ratio above 5.7 (highest quartile) reported 91.1% specificity, 4.51 odds ratio (CI 95% 1.51 to 13.45) for the final diagnosis of ACS when compared to the groups at lower quartiles. CONCLUSION: The N/L ratio presents correlation with final diagnosis of patients with suspicion of ACS at admission. Considering this is a low cost, good reproductibility test, new studies should ellucidate whether the ratio may be of relevance for diagnosis flowcharts currently in use.

Read Full Article