The relationship between corrected QT interval and neutrophil to lymphocyte ratio in patients with acute coronary syndrome

Year 2021, Volume: 5 Issue: 2, 158 - 162, 01.02.2021

Saadet Demirtas Inci , Mehmet Erat

https://doi.org/10.28982/josam.867770

Abstract

Background/Aim: In recent years, prolonged corrected QT (QTc) interval is thought to be an independent risk factor in patients with Acute Coronary Syndrome (ACS). Our aim in this study is to determine whether there is a relationship between the Neutrophil/Lymphocyte Ratio (NLR), which is a new inflammatory parameter, and prolonged QTc corrected (QTc) interval in patients with ACS.
Methods: In a retrospective cohort study, 649 patients with ACS were enrolled from January 2017 to July 2019, out of which ninety-two patients died during follow-up. Patients were divided into two groups according to the prolonged QTc interval (QTc ≥450 msec). The relationship between QTc interval prolongation and NLR was evaluated. The primary endpoint was early all-cause death.
Results: Thirty-one of 135 patients (22.9% P=0.002) with QTc interval prolongation and 61 of 514 patients without QTc prolongation (11.8% P=0.002) died. Prolonged QTc interval was positively correlated with NLR (r=0.20, P=0.001). Both NLR (OR: 1,016; 95% CI: 1.004–1.028; P=0.01) and QTc interval (OR: 1.016; 95% CI: 1.004–1.028; P=0.006) independently predicted early mortality. In the ROC curve analysis, the AUC value of QTc interval to predict in-hospital mortality was 0.680 (95% CI: 0.597-0.763; P=0.001), with a sensitivity of 35%, a specificity of 82% and an optimum cut-off value of ≥450 msec. The AUC value of NLR to predict in-hospital mortality was 0.711 (95% CI: 0.653-0.769; P<0.001), with a sensitivity of 64%, a specificity of 68% and an optimum cut-off value of ≥3.9.
Conclusion: In this study, we showed that prolonged QTc interval was positively associated with NLR, which is an indicator of systemic inflammation in patients with ACS, for the first time. Also, QTc interval prolongation and increased NLR were independent predictors of early mortality.

Keywords

Systemic inflammation,, early mortality, electrocardiography

Project Number

yok

References

• 1. Smith JN, Negrelli JM, Manek MB, Hawes EM, Viera AJ. Diagnosis and Management of Acute Coronary Syndrome: An Evidence-Based Update. The Journal of the American Board of Family Medicine. 2015;28(2):283-93.
• 2. Jiménez-Candil J, Diego M, Cruz González IC, Matas J M G, Martín F, Pabón P, et al: Relationship between the QTc interval at hospital admission and the severity of the underlying ischaemia in low and intermediate risk people studied for acute chest pain. Int J Cardiol. 2008;126:84–9.
• 3. Lazzerini PE, Capecchi PL, Laghi-Pasini F. Long QT syndrome: an emerging role for inflammation and immunity. Front Cardiovasc Med 2015;2:26. doi: 10.3389/fcvm.2015.00026.
• 4. Fiechter M, Ghadri JR, Jaguszewski M, Siddique A, Vogt S, Haller RB, et al. Effect of inflammation on adverse cardiovascular events in patients with acute coronary syndrome. J Cardiovasc Med (Hagerstown). 2013;14(11):807-14.
• 5. Choi DH, Kobayashi Y, Nishi T, Kim HK, Ki YJ, Kim SS, et al. Combination of mean platelet volume and neutrophil to lymphocyte ratio predicts long-term major adverse cardiovascular events after percutaneous coronary intervention. Angiology. 2019;70:345–51.
• 6. Thygesen K, Alpert JS, Harvey D, Jaffe AS, Apple FS, Galvani M, et al. White on behalf of the Joint ESC/ACCF/AHA/WHF Task Force for the redefinition of myocardial infarction. Universal definition of myocardial infarction. Eur Heart J. 2007;28:2525–38.
• 7. Hamm C, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. E SC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2011;32:2999–3054.
• 8. Savonitto S, Ardissino D, Granger CB, Morando G, Prando MD, Mafrici A, et al. Prognostic value of the admission electrocardiogram in acute coronary syndromes. JAMA.1999;281:707.
• 9. Rautaharju PM, Surawicz B, Gettes LS, et al: AHA/ACC/HRS recommendations for the standardization and interpretation of the electrocadiogram part IV: The ST segment, T and U waves, and the QT interval. A scientific statement from the American Heart Association Electrocardiography and Arrhythmias Committee, Council on Clinical Cardiology; the American College of Cardiology Foundation; and the Heart Rhythm Society Endorsed by the International Society for Computerized Electrocardiology. J Am Coll Cardiol. 2009;53:982–91.
• 10. Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.
• 11. Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al; Intermountain Heart Collaborative Study Group. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45(10):1638-43.
• 12. Gurm HS, Bhatt DL, Lincoff AM, Tcheng JE, Kereiakes DJ, Kleiman NS, et al. Impact of preprocedural white blood cell count on long term mortality after percutaneous coronary intervention: insights from the EPIC, EPILOG, and EPISTENT trials. Heart. 2003;89(10):1200-4.
• 13. Oncel RC, Ucar M, Karakas MS, Akdemir B, Yanikoglu A, Gulcan AR, et al. Relation of neutrophil-to-lymphocyte ratio with GRACE risk score to in-hospital cardiac events in patients with ST-segment elevated myocardial infarction. Clin Appl Thromb Hemost. 2015;21(4):383-8.
• 14. Soylu K, Gedikli O, Dagasan G, Aydin E, Aksan G, Nar G, et al. Neutrophil-to-lymphocyte ratio predicts coronary artery lesion complexity and mortality after non-ST-segment elevation acute coronary syndrome. Rev Port Cardiol. 2015;34(7-8):465-71.
• 15. Guasti L, Dentali F, Castiglioni L, Maroni L, Marino F, Squizzato A, et al. Neutrophils and clinicaloutcomes in patients with acute coronary syndromes and/or cardiacrevascularisation. A systematic review on more than 34,000 subjects. Thromb Haemost. 2011;106:591–9.
• 16. Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiryet G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Expert Rev Cardiovasc Ther. 2013;11:55–9. doi: 10.1586/erc.12.159.
• 17. Kucuk U, Arslan M. Assessment of the white blood cell subtypes ratio in patients with supraventricular tachycardia: Retrospective cohort study. J Surg Med. 2019;3(4):297-9.
• 18. Lewek J, Kaczmarek K, Cygankiewicz I, Wranicz JK, Ptaszynski P. Inflammation and arrhythmias: potential mechanisms and clinical implications. Expert Rev Cardiovasc Ther. 2014;12(9):1077-85.
• 19. Drew BJ, Ackerman MJ, Funk M, Gibler WB, Kligfield P, Menon V, et al. Prevention of torsade de pointes in hospital settings: a scientific statement from the American Heart Association and the American College of Cardiology Foundation. Circulation. 2010;121:1047–60.
• 20. Kenigsberg DN, Santaya K, Khanal S, Kowalski M, Krishnan SC. Prolongation of the QTc interval is seen uniformly during early transmural isquemia. J Am Coll Cardiol. 2007;49:1299-305.
• 21. Kim E, Joo SJ, Kim J, Ahn JC, Kim JH, Kimm K, et al. Association between C-reactive protein and QTc interval in middle-aged men and Women. European Journal of Epidemiology. 2006;21:653–9.
• 22. Lazzerini PE, Laghi-Pasini F, Bertolozzi I, Morozzi G, Lorenzini S, Simpatico A, et al. Systemic inflammation as a novel QT-prolonging risk factor in patients with torsades de pointes. Heart. 2017;0:1–9. doi: 10.1136/heartjnl-2016-311079.
• 23. Chang KT, Shu HS, Chu CY, Lee WH, Hsu PC, Su HM, et al. Association between C-reactive protein, corrected QT interval and presence of QT prolongation in hypertensive patients. Kaohsiung J Med Sci. 2014;30:310–5. doi: 10.1016/j.kjms.2014.02.012.
• 24. Yue W, Schneider A, Rückerl R, Koenig W, Marder V, Wang S, et al. Relationship between electrocardiographic and biochemical variables in coronary artery disease. Int J Cardiol. 2007;119:185–91. doi: 10.1016/j.ijcard.2006.07.129.
• 25. Nowinski K, Jensen S, Lundshl G, Bergfeldt L. Changes in ventricular repolarization during percutaneous transluminal coronary angioplasty in humans assessed by QT interval, QT dispersion and T vector loop morphology. J Intern Med. 2000;248:126–36.