Akut İskemik İnme Geçiren Hastalarda Sol Atrial Appendaj Trombüs Oluşumu ve Monosit/HDL Oranı Arasındaki İlişki

Year 2023, , 248 - 254, 30.06.2023

Süha Çetin , Mustafa Gökhan Vural

https://doi.org/10.53446/actamednicomedia.1224287

Abstract

Amaç: Trombüs oluşumu ve enflamasyon arasında kuşkusuz bir bağlantı bulunmaktadır. Monsit/HDL oranı (MHO) bir enflamasyon göstergesi olup, birçok kardiyovasküler hastalıkla (örneğin: koroner arter hastalığı, akut koroner stent trombozu, koroner trombüs yükü, atriyal fibrilasyon (AF))ilişkilidir.
Yöntem: Akut iskemik inme teşhisi olan toplam 69 hasta retrospektif olarak bu çalışmaya dahil edildi. Demografik, klinik ve ekokardiyografik veriler hasta dosyalarından retrospektif olarak toplandı. MHO ve nötrofil/lenfosit oranları (NLO) mevcut olan laboratuvar bulgularından hesaplandı.
Bulgular: MHO ve NLO arasında anlamlı bir korelasyon mevcuttu r=0,6; p<0,001). 13 hastada sol atriyal appendaj trombüsü (APT) teşhisi konuldu (11 erkek; yaş 64,1±14,5); 14 hastada spontan eko kontrast (SEK) evre 3 veya 4 teşhisi mevcuttu (11 erkek; yaş 62,3±9,7); 42 hastanın ne sol APT ne de SEK görüntüsü mevcuttu (29 erkek; yaş 61,0±11,1). AF (p<0,001) haricinde 3 grup arasında demografik ve klinik bulgularda anlamlı bir fark yoktu. Monosit seviyesi trombüs negatif olan grupta diğer gruplara kıyasla daha düşüktü (p<0,001). MHO her grup için anlamlı bir fark gösterdi (p<0,001). Bu parametre sol APT ve SEK bulguları olan hastalarda anlamlı yüksekti.
Sonuç: Çalışmamız yükselmiş bir monosit/HDL oranının sol APT oluşumu ile ilişkili olduğunu gösterdi.

Keywords

Monosit/HDL oranı, sol atrial appendaj, atriyal fibrillasonyon

Association Between Left Atrial Appendage Thrombus Formation and Monocyte/HDL Ratio in Patients with Acute Ischemic Stroke

Abstract

Objective: There is an apparent link between thrombus formation and inflammation. Monocyte/HDL ratio (MHR) has been determined as an inflammatory marker and associated with many cardiovascular disorders like coronary artery disease, acute coronary stent thrombus, coronary thrombus burden and atrial fibrillation (AF). The purpose of this study was to elucidate the association between MHR and left atrial appendage thrombus formation (AATF) in patients with acute ischemic stroke.
Methods: A total of 69 patients with the diagnosis of acute ischemic stroke were retrospectively enrolled in the study. Demographic, clinical and echocardiographic data were collected retrospectively from the patients’ records. MHR and neutrophil/lymphocyte ratio (NLR) were calculated from the present laboratory data.
Results: There was a significant positive correlation between MHR and NLR (r=0.6; p<0.001). Thirteen patients had a left AATF (11 male; 64±14.5 years); 14 patients had spontaneous echo contrast (SEC) stage 3 or 4 (11 male; 62.3±9.7 years) and 42 patients (29 male; 61.0±11.1 years) did not have left AATF or SEC. There was no difference between the 3 groups in terms of baseline demographic or clinical findings except AF (p<0.001). Further, monocytes were significantly lower in the thrombus negative group compared to other groups (p<0.001). MHR was different in all three groups (p<0.001). This parameter was significantly increased in patients with left AATF and SEC finding.
Conclusion: Our study showed that an increased MHR is associated with left AATF.

Keywords

Monocyte/HDL ratio, left atrial appendage, atrial fibrillation

References

• 1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke. 1991;22:983-988. doi:10.1161/01.str.22.8.983
• 2. Lip GY. Does atrial fibrillation confer a hypercoagulable state? Lanceti 1995;346:1313-1314. doi:10.1016/s0140-6736(95)92339-x
• 3. Choudhury A, Lip G. Atrial fibrillation and the hypercoagulable state: From basic science to clinical practice. Pathophsiol Haemost Thromb. 2003:33(5-6):282-289. doi:10.1159/000083815
• 4. Violi F, Pastori D, Pignatelli P. Mechanisms of management of thrombo-embolism in atrial fibrillation. J Atr Fibrillation. 2014;7(3):1112. doi:10.4022/jafib.1112
• 5. Maehama T, Okura H, Imai K, et al. Systemic inflammation and left atrial thrombus in patients with non-rheumatic atrial fibrillation. J Cardiol. 2010;56(1):118-124. doi:10.1016/j.jjcc.2010.03.006
• 6. Arısoy A, Altunkaş F, Karaman K, et al. Association of the monocyte to HDL cholesterol ratio with thrombus burden in patients with ST-segment elevation myocardial infarction. Clin Appl Thromb Hemost. 2017;23(8):992-997. doi:10.1177/1076029616663850
• 7. Cetin EH, Cetin MS, Canpolat U, et al. Monocyte/HDL-cholesterol ratio predicts the definite stent thrombosis after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. Biomark Med. 2015;9(10):967-977. doi:10.2217/bmm.15.74
• 8. Nozawa N, Hibi K, Endo M, et al. Association between circulating monocytes and coronary plaque progression in patients with acute myocardial infarction. Circ J. 2010;74(7):1384-1391. doi:10.1253/circj.cj-09-0779
• 9. Afiune Neto A, Mansur Ade P, Avakian SD, Gomes EP, Ramires JA. Monocytosis is an independent risk marker for coronary artery disease. Arq Bras Cardiol. 2006;86(3):240-244. doi:10.1590/s0066-782x2006000300013
• 10. Hessler JR, Robertson AL, Chisolm GM. LDL-induced cytotoxicity and its inhibition by HDL in human vascularsmooth muscle and endothelial cells in culture. Atherosclerosis. 1979;32(3):213-229. doi:10.1016/0021-9150(79)90166-7
• 11. Li XP, Zhao SP, Zhang XY, Liu L, Gao M, Zhou QC. Protective effect of high-density lipoprotein and endothelium-dependent vasodilatation. Int J Cardiol. 2000;73(3):231-236. doi:10.1016/s0167-5273(00)00221-7
• 12. Chen SA, Zhang MM, Zheng M, et al. The preablation monocyte/ high density lipoprotein ratio predicts the late recurrence of paroxysmal atrial fibrillation after radiofrequency ablation. BMC Cardiovascular Disord. 2020;20:401. doi:10.1186/s12872-020-01670-3
• 13. Sercelik A, Besnili AF. Increased monocyte to high-density lipoprotein cholesterol ratio is associated with TIMI risk score in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol. 2018;37(3):2017-2023. doi:10.1016/j.repc.2017.06.021
• 14. Wang J, Zhang L, Wang F, Liu L, Wang H and China National Survey of Chronic Kidney Disease Working Group. Prevalence, awareness, treatment, and control of hypertension in China: Results from national survey. Am J Hypertens. 2014;27:1355-1361. doi:10.1093/ajh/hpu053
• 15. Olafsdottir E, Andersson DK, Dedorsson I, Stefansson E. The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus. Acta Ophtalmol. 2014;92:133-137. doi:10.1111/aos.12095
• 16. Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Atherosclerosis. 2019;290:140-205. doi:10.1093/eurheartj/ehz455
• 17. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi:10.1093/eurheartj/ehaa612
• 18. Shiller NB, Shah PM, Crawford M, et al. Recommendations for quantification of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr. 1988;2:358-367. doi:10.1016/s0894-7317(89)80014-8
• 19. Armstrong WF, Ryan T. Left and right atrium, and right ventricle. In: Armstrong WF, Ryan T (eds.), Feigenbaum’s Echocardiography. 8th ed. Philadelphia: Wolters Kluwer; 2019. p. 542-639.
• 20. Armstrong WF, Ryan T. Evaluation of diastolic function. In: Armstrong WF, Ryan T (eds.), Feigenbaum’s Echocardiography. 8th ed. Philadelphia: Wolters Kluwer; 2019. p. 462-541.
• 21. Herring N, Page SP, Ahmed M, et al. The prevalence of low left atrial appendage emptying velocity and thrombus in patients undergoing catheter ablation for atrial fibrillation on uninterrupted peri-procedural warfarin therapy. J Atr Fibrillation. 2013;5(6):761. doi:10.4022/jafib.761
• 22. Ito T, Suwa M. Left atrial spontaneous echo contrast: relationship with clinical and echocardiographic parameters. Echo Res. Pract. 2019;6(2):R65-R73. doi:10.1530/ERP-18-0083
• 23. Tani S, Matsumoto M, Anazawa T, et al. Development of a model for prediction of coronary atherosclerotic regression: evaluation of high-density lipoprotein cholesterol level and peripheral blood monocyte count. Heart Vessel. 2012;27(2):143-150. doi:10.1007/s00380-011-0130-8
• 24. Krieger E, van Der Loo B, Amann-Vesti BR, Rousson V, Koppensteiner R. C-reactive protein and red cell aggregation correlate with late venous function after acute deep venous thrombosis. J Vasc Surg. 2004;40(4):644-649. doi:10.1016/j.jvs.2004.07.004
• 25. Watanabe H, Tanabe N, Yagihara N, Watanabe T, Aizawa Y, Kodama M. Association between lipid profile and risk of atrial fibrillation. Circ J. 2011;75:2767-2774. doi:10.1253/circj.cj-11-0780
• 26. Murphy AJ, Wooland KJ, Hoang A, et al. High-density lipoprotein reduces the human monocyte inflammatory response. Arterioscler Thromb Vasc Biol. 2008;28(11):2071-2077. doi:10.1161/ATVBAHA.108.168690
• 27. Durmus G. The relationship between coronary thrombus burden and monocyte to high-density lipoprotein cholesterol ratio in patients with acute non-ST elevation myocardial infarction. Istanbul Med J. 2019;20(5):389-393. doi:10.4274/imj.galenos.2019.12979
• 28. Avci A, Biricik S, Avci BS, et al. The new prognostic factor for pulmonary embolism: The ratio of monocyte count to HDL cholesterol. Am J Emerg Med. 2021;46:2012-2016. doi:10.1016/j.ajem.2020.07.026
• 29. Isik T, Ayhan E, Uyarel H, et al. Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasia. Turk Kardiol Dern Ars. 2013;41(2):123-130. doi:10.5543/tkda.2013.17003
• 30. Violi F, Pastori D, Pignatelli P. Mechanisms and management of thrombo-embolism in atrial fibrillation. J Atr Fibrillation. 2014;7(3):1112. doi:10.4022/jafib.1112
• 31. Black IW, Chesterman CN, Hopkins AP, Lee LC, Chong BH, Walsh WF. Hematologic correlates of left atrial spontaneous echo contrast and thromboembolism in nonvalvular atrial fibrillation. Am Coll Cardiol. 1993;21:451-457. doi:10.1016/0735-1097(93)90688-w
• 32. Nightingale T, Cutler D. The secretion of von Willebrand factor from endothelial cells; an increasingly complicated story. JTH. 2013;11 Suppl 1:192-201. doi:10.1111/jth.12225
• 33. Heppell RM, Berkin KE, McLenachan JM, Davies JA. Hemostatic and hemodynamic abnormalities associated with left atrial thrombosis in non-rheumatic atrial fibrillation. Heart. 1997;1:2453-2455. doi:10.1136/hrt.77.5.407
• 34. Boos CJ, Anderson RA, Lipp GY. Is atrial fibrillation an inflammatory disorder? Eur Heart J. 2006;27:136. doi:10.1093/eurheartj/ehi645
• 35. Conway DS, Buggins P, Hughes E, Lipp GY. Relationship of interleukin-6 and C-reactive protein to the prothrombotic state in chronic atrial fibrillation. J Am Coll Cardiol. 2004;43:2075. doi:10.1016/j.jacc.2003.11.062
• 36. Conway DS, Buggins P, Hughes E, Lipp GY. Relation of interleukin-6, C-reactive protein, and prothrombotic state to transesophageal echocardiographic findings in atrial fibrillation. Am J Cardiol. 2004;93:1368. doi:10.1016/j.amjcard.2004.02.032
• 37. Fukuchi M, Watanabe J, Kumagai K, et al. Increased von Willebrand factor in the endocardium as a local predisposing factor for thrombogenesis in overloaded human atrial appendage. J Am Coll Cardiol. 2001;37:1436-1442. doi:10.1016/s0735-1097(01)01125-1
• 38. Chen J, Chung DW. Inflammation, von Willebrand factor, and ADAMTS13. Blood. 2018;132(2):141-147. doi:10.1182/blood-2018-02-769000
• 39. Nakamura Y, Nakamura K, Fukushima-Kusano K, et al. Tissue factor expression in atrial endothelia associated with non-valvular atrial fibrillation: possible involvement in intracardiac thrombogenesis. Thromb Res. 2003;111:137-142. doi:10.1016/s0049-3848(03)00405-5
• 40. Yamashita T, Sekiguchi A, Iwasaki YK, et al. Recruitment of immune cells across atrial endocardium in human atrial fibrillation. Circ J. 2010;74:262-270. doi:10.1253/circj.cj-09-0644
• 41. Ghattas A, Griffiths HR, Devitt A, Lip GY, Shantsilla E. Monocytes in coronary artery disease and atherosclerosis: where are we now? J Am Coll Cardiol. 2013; 62:1541-1551. doi:10.1016/j.jacc.2013.07.043