AIM To investigate the relationship between serum neutrophil-to-lymphocyte ratio (NLR) level and left ventricular ejection fraction (LVEF), as well as prognosis in patients with acute myocardial infarction (AMI).
METHODS A total of 813 patients diagnosed with AMI who had undergone coronary angiography in our hospital from July 2017 to December 2018 were enrolled in this study and their data were analyzed retrospectively. The patients were divided into 3 groups based on serum NLR levels and the differences in baseline data and clinical biochemical indicators were compared between the groups. Regression analysis was conducted to examine the relationship between serum NLR and left ventricular ejection fraction (LVEF). A 12-month follow-up was performed and the occurrence rate of cardiovascular events was compared.
RESULTS The NLR levels and other indicators such as heart rate (HR), white blood cell count, blood creatinine, serum D-dimer, hypersensitive C-reactive protein, GRACE score, and Gensini score of AMI patients in the LVEF reduced group were significantly higher than those in the LVEF normal group, and the differences were statistically significant (all P<0.05). The systolic blood pressure of AMI patients in the LVEF reduced group was lower than that of AMI patients in the LVEF normal group, and the difference was statistically significant (P<0.05). Comparison of the NLR level in the three quantile group: LVEF (both adjacent and cross group P<0.01) and other items of diabetes history (both adjacent and cross group P<0.01), admission systolic pressure (both adjacent and cross group P<0.05) decreased with the increase of the NLR triple, and glycosylated hemoglobin HIGH NLR group was lower than LOW NLR GROUP and MIDDLE NLR groups (both P<0.01), but there was no difference between LOW NLR GROUP and MIDDLE NLR groups. At the same time, the admission heart rate (HR), white blood cell count, blood creatinine, and GRACE score of the three groups all increased with the increase of NLR interquartile, and most items were P<0.01 between adjacent and cross groups. The MIDDLE NLR and HIGH NLR groups of D-dimer were higher than the LOW NLR GROUP (all P<0.01), but there was no difference between MIDDLE NLR and HIGH NLR. Linear regression analysis suggests a significant negative correlation between NLR levels and LVEF. Further multiple factor linear regression analysis was conducted, and the results showed that NLR (β=−Heart rate of 0.248 (P<0.01) and other items (β=−0.121, P<0.01), GRACE score (β=−0.043, P<0.05), Gensini score (β=−0.036 (P<0.01) is negatively correlated with LVEF and systolic blood pressure (β=0.088 (P<0.01) is positively correlated with LVEF. In the 12 month follow-up observation, the incidence of heart failure in patients with high NLR was higher than that in patients with low NLR (6.88% vs. 3.69%, P<0.05), and the incidence of malignant arrhythmia in patients with high NLR was higher than that in patients with low NLR (5.65% vs. 2.71%, P<0.05).
CONCLUSION The levels of serum NLR are negatively correlated with the left ventricular ejection fraction in AMI patients. Serum NLR is closely related to the prognosis of occurrence rate of heart failure and malignant arrhythmias during the 12-month follow-up.