Mustafa Aparci

The Relation Between Atherosclerosis and the Neutrophil–Lymphocyte Ratio

Inflammation plays an important role in the pathophysiology of vascular disease. In this review, we consider the associations between the neutrophil–lymphocyte ratio (NLR; an indicator of inflammation) and vascular disease and its associated risk factors. The NLR has received attention due to its role as an independent prognostic factor for coronary artery disease. The NLR can also be affected by atherosclerotic risk factors, such as hypercholesterolemia, metabolic syndrome, diabetes, and hypertension. Importantly, it can predict mortality in cardiovascular diseases. There are also reports of a positive correlation between the NLR and commonly used inflammatory markers. Inflammation is important not only in pathophysiology but also clinical outcomes of many diseases. The NLR is a widely available, easily derived, and reproducible marker of inflammation. Unlike many other inflammatory markers, the NLR is inexpensive and readily available and it provides additional risk stratification beyond conventional risk scores.

Allopurinol improves endothelial function and reduces oxidant-inflammatory enzyme of myeloperoxidase in metabolic syndrome

ObjectiveIn this study, we tested in patients with metabolic syndrome whether allopurinol through decreasing oxidative stress improves endothelial function, and ameliorates inflammatory state represented by markers of myeloperoxidase, C-reactive protein (CRP) and fibrinogen.MethodsIn a randomized, double-blind fashion; subjects with metabolic syndrome were treated with allopurinol (n = 28) or placebo (n = 22) for one month. Before and after treatment, blood samples were collected and the flow-mediated dilation (FMD) and isosorbide dinitrate (ISDN)-mediated dilation of the brachial artery were performed.ResultsBaseline clinical characteristics of the allopurinol and placebo groups demonstrated no differences in terms of clinical characteristics, endothelial function and inflammatory markers. After the treatment with allopurinol, FMD was increased from 8.0 ± 0.5 % to 11.8 ± 0.6% (P < 0.01), but there were no change in the placebo group. In both groups, ISDN-mediated dilation is unaffected by the treatment. As a marker of oxidative stress, allopurinol significantly reduced malondialdehyde. Moreover, myeloperoxidase levels were reduced by the treatment with allopurinol (56.1 ± 3.4 ng/ml vs. 44.4 ± 2.4 ng/ml, P < 0.05) but there were no change in the placebo group. Surprisingly, neither CRP nor fibrinogen levels were affected by the treatment in both groups.ConclusionXanthine oxidoreductase inhibition by allopurinol in patients with metabolic syndrome reduces oxidative stress, improves endothelial function, ameliorates myeloperoxidase levels and does not have any effect on CRP and fibrinogen levels.

Prognostic significance of ischemia-modified albumin in patients with acute coronary syndrome.

To improve prognosis in acute coronary syndrome, new clinical applications in terms of diagnosis, risk stratification, and treatment strategies are still under investigation. Ischemia-modified albumin was one of the novel markers of myocardial ischemia. In our study, we aimed to determine the prognostic significance of the albumin cobalt binding capacity test in patients with acute coronary syndromes. We compared the ischemia-modified albumin levels of patients with acute coronary syndrome with those of patients with stable coronary artery disease and those of normal individuals and found them to be significantly higher in the first group (P<0.05). A cutoff value of ischemia-modified albumin of 477 U/ml was found by using receiver operating characteristic curve analysis. Mortality in groups of patients whose ischemia-modified albumin levels were above 477 U (50%) was found to be significantly higher than in those whose levels were below 477 U (8.3%) (P<0.05). The sensitivity and specificity of the cutoff value, 477 U/ml, for the 1-year mortality were found to be 70 and 82%, respectively. Using the Cox regression model the relation of albumin cobalt binding capacity test results with mortality was statistically significant (&bgr;=1.013, confidence interval 95%, P=0.01) and independent of the existence of hypertension, diabetes, and advanced age. In conclusion, ischemia-modified albumin was found to be significantly related to 1-year mortality. Prognostic significance of ischemia-modified albumin should be evaluated in large populated and randomized study groups. Afterwards, ischemia-modified albumin could be used in risk stratification modality in patients with acute coronary syndrome.

Relationship of cystatin C with coronary artery disease and its severity.

ObjectiveCystatin C, which is an endogenous marker for renal function, is reported to be a novel marker for coronary atherosclerosis. In this study, we aimed to evaluate its role in determining the presence and also the severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Materials and methodsEighty-eight patients who underwent elective coronary angiography were enrolled in the study. Patients with heart failure, renal failure, diabetes, and thyroid disease were excluded from the study. The study population was divided into three groups: individuals with normal coronary arteries, patients with critical CAD, and patients with noncritical CAD. We also analyzed the relationship of cystatin C levels with the presence and the severity of CAD and the number of vessels involved. ResultsThe mean age of the study group was 51.73±9.21 years, and the majority were men (n=71, 80.7%). Cystatin C levels were significantly lower in patients with CAD (1334.86±93.45 vs. 836.49±411.29, P<0.001). It was significantly lower in patients with critical CAD compared with those with noncritical CAD and normal individuals (656.60±346.35, 1016.38±396.54, and 1334.86±393.45, P<0.001, respectively). Serum levels of cystatin C according to the numbers of coronary vessels such as none, single-vessel, two-vessel, three-vessel, and four-vessel disease were as follows: 1334.86±393.45, 801.67±418.70, 993.90±457.34, 744.09±354.53, and 682.30±294.43, respectively. ConclusionLower cystatin C levels may be associated with increased severity of CAD in clinically stable patients, whereas higher levels may indicate the presence of any vulnerable plaque. It may also guide the diagnostic and therapeutic options for the clinical scene on the presentation.

Neutrophil–Lymphocyte Ratio May Predict Left Atrial Thrombus in Patients With Nonvalvular Atrial Fibrillation

Objective: Neutrophil–lymphocyte ratio (NLR) has been associated with poor outcomes in patients with cardiovascular diseases. We aimed to compare NLRs among patients with nonvalvular atrial fibrillation (AF) with or without left atrial (LA) thrombus. Methods: A total of 309 (70.1 ± 9.8 years, 49% male) patients with nonvalvular AF have undergone transoesophageal echocardiography (TEE) to assess the presence of LA thrombus. Baseline NLR was measured by dividing neutrophil count to lymphocyte count. Results: Left atrial thrombus was detected in 32 (10.3%) of 309 patients. Mean NLR (2.2 ± 1.0 vs 2.7 ± 1.1, P = .026) was significantly higher among patients with LA thrombus compared to patients without LA thrombus. On multivariate analysis, NLR (odds ratio 1.59, 95% confidence interval 0.87-4.18; P < .02) was an independent risk factor for the presence of LA thrombus in patients with nonvalvular AF. Conclusion: Neutrophil–lymphocyte ratio, an emerging marker of inflammation, was independently associated with the presence of LA thrombus in patients with nonvalvular AF.

Predictors of No-Reflow Phenomenon in Young Patients With Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

No-reflow is of prognostic value in ST-segment elevation myocardial infarction (STEMI) but has not been extensively investigated in young patients. Young patients with STEMI admitted within 12 hours from symptom onset and treated by primary percutaneous coronary intervention (pPCI) were recruited. Patients were classified into 2 groups based on postintervention thrombolysis in myocardial infarction (TIMI) flow grade; no-reflow: TIMI flow grade 0, 1 or 2 (group 1; n = 27; 21 men, mean age: 42 ± 4 years); and angiographic success: TIMI flow grade 3 (group 2; n = 118; 110 men, mean age: 43 ± 4 years). Adjusted odds ratios were 13.79 for female gender (P < .001; confidence interval [CI] = 1.88-101.26), 2.09 for pain to balloon time (P < .017; CI = 1.14-3.812), 12.29 for high TIMI thrombus grade (P = .012; CI = 1.74-86.94), 0.04 for tirofiban use (P < .001; CI = 0.01-0.22), 5.19 for mean platelet volume (MPV; P < .001; CI = 2.44-11.01), and 1.008 for platelet–lymphocyte ratio (PLR; P = .034; CI = 1.001-1.016). In conclusion, female gender, pain to balloon time, high TIMI thrombus grade, tirofiban, MPV, and PLR were independent predictors of no-reflow in young patients with STEMI after pPCI.

The lymphocyte-monocyte ratio in clinical practice

We read the article ‘Pretreatment lymphocyte-monocyte ratio (LMR) as a potential prognostic factor in a cohort of patients with upper tract urothelial carcinoma’ by Hutterer et al .1 They aimed to investigate the potential prognostic impact of the LMR in a large European cohort of patients with localised upper urinary tract urothelial carcinoma. They concluded that LMR might be considered an additional prognostic factor in upper urinary tract urothelial carcinoma in the future. A complete blood count is an easy examination technique that gives us information about the patients’ formed …

Relationship between P-Wave Dispersion and Effective Hemodialysis in Chronic Hemodialysis Patients

Objective: To investigate whether or not P-wave dispersion (PWD) can be used as a good indicator of effective hemodialysis. Subjects andMethods: The study included 35 patients (20 males, 15 females, mean age 61 ± 10 years) who regularly received hemodialysis treatment for chronic renal failure. Following hemodialysis, the patients whose hemodynamic parameters were preserved and who reached dry body weight were included. Twelve-lead resting electrocardiogram (ECG) at a speed of 25–50 mm/s, the value of total body fluid (TBF) and bioelectric impedance using bipedal bioelectric impedance equipment were obtained before and immediately after hemodialysis. Blood samples were also taken for the assessment of blood electrolytes, urea and creatinine. PWD was defined as the difference between the maximum and minimum P-wave duration calculated on a standard 12-lead ECG before and after dialysis. Results: The following parameters were obtained before and after hemodialysis: blood pressure 132 ± 21 vs. 130 ± 10 mm Hg (p > 0.05), TBF 33.9 ± 6 vs. 32 ± 5.6 liters (p = 0.001), impedance 499 ± 110 vs. 596 ± 136 Ω (p = 0.001), P-max 103.1 ± 8.9 vs. 106.3 ± 12.7 ms (p > 0.05), P-min 70.2 ± 11 vs. 72.5 ± 7.9 ms (p > 0.05), PWD 32.2 ± 11.9 vs. 33.8 ± 13.4 ms (p > 0.05). Although statistically significant decreases were observed in urea and creatinine levels after hemodialysis, no such changes were observed in blood electrolytes. Conclusion: The P-max and PWD did not change significantly after hemodialysis, hence these two parameters can be used as an indicator of effective hemodialysis.

The relation between lymphocyte-monocyte ratio and renal cell carcinoma.

To the Editor: We read with great interest the article “Low preoperative lymphocyte-monocyte ratio (LMR) represents a potentially poor prognostic factor in nonmetastatic renal cell carcinoma” (RCC), by Hutterer et al. [1]. They aimed to provide the potential prognostic significance of the LMR in patients with RCC, as the LMR has been repeatedly proposed to have a negative effect on patients survival in various hematological and solid cancers. They concluded that regarding cancer-specific survival of patients with RCC, a decreased LMR represents an independent prognostic factor. A complete blood count is an easy examination technique that gives us information about the patients formed blood contents; the red and white cells, the platelets, the count and dimensions of subgroups of cells, and parameters. Even when white blood cells count is in normal range, subtype count of white blood cells may predict cardiovascular mortality. Although the mechanisms for the relationship between increasing LMR and dismal outcome have not been elucidated, a high monocyte count or a low lymphocyte count has been reported as an adverse biomarker of prognosis in various cancers. Lymphocyte count was recognized as a predictor of favorable outcome whereas monocyte count was a predictor of poor outcome. In recent years, The LMR was demonstrated to be an independent prognostic factor mainly in some cancers. However, certain conditions that may be related to LMR should be recognized when LMR is assessed. These conditions are metabolic syndrome, acute coronary syndromes, abnormal result thyroid function tests, renal or hepatic dysfunction, local or systemic inflammation, history of infection, inflammatory diseases, and any medication related to inflammatory condition of patients [2]. It would have been better if the authors had mentioned these factors. Recently the LMR has been used to determine the severity of inflammation in some patients with cancer [3]. However, low-LMR levels may be also associated with

The neutrophil lymphocyte ratio in coronary heart disease

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