Neutrophil to Lymphocyte Ratio and Outcomes in Patients with New-Onset or Worsening Heart Failure with Reduced and Preserved Ejection Fraction

Inflammation is thought to play a role in heart failure (HF) pathophysiology. Neutrophil-to-lymphocyte ratio (NLR) is a simple, routinely available measure of inflammation. Its relationship with other inflammatory biomarkers and its association with clinical outcomes in addition to other risk markers have not been comprehensively evaluated in HF patients. Methods We evaluated patients with worsening or new-onset HF from the BIOlogy Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study who had available NLR at baseline. The primary outcome was time to all-cause mortality or HF hospitalization. Outcomes were validated in a separate HF population. Results 1622 patients were evaluated (including 523 ventricular ejection fraction [LVEF] < 40% and 662 LVEF ≥ 40%). NLR was significantly correlated with biomarkers related to inflammation as well as NT-proBNP. NLR was significantly associated with the primary outcome in patients irrespective of LVEF (hazard ratio [HR] 1.18 per standard deviation increase; 95% confidence interval [CI] 1.11–1.26, P < 0.001). Patients with NLR in the highest tertile had significantly worse outcome than those in the lowest independent of LVEF (<40%: HR 2.75; 95% CI 1.84–4.09, P < 0.001; LVEF ≥ 40%: HR 1.51; 95% CI 1.05–2.16, P = 0.026). When NLR was added to the BIOSTAT-CHF risk score, there were improvements in integrated discrimination index (IDI) and net reclassification index (NRI) for occurrence of the primary outcome (IDI + 0.009; 95% CI 0.00–0.019, P = 0.030; continuous NRI + 0.112, 95% CI 0.012–0.176, P = 0.040). Elevated NLR was similarly associated with adverse outcome in the validation cohort. Decrease in NLR at 6 months was associated with reduced incidence of the primary outcome (HR 0.75; 95% CI 0.57–0.98, P = 0.036). Conclusions Elevated NLR is significantly associated with elevated markers of inflammation in HF patients and is associated with worse outcome. Elevated NLR might potentially be useful in identifying high-risk HF patients and may represent a treatment target

E-page Original Images. Thrombotic lesion of saphenous vein graft resolved by antiaggregant therapy.

PubMedID: 18400618[No abstract available

Myocarditis: Medical education [Miyokardit]

Myocarditis is an inflammatory disorder of the myocardium with necrosis of myocytes and associated inflammatory infiltrate. Although the etiological agent is usually a virus, some bacteria, fungi, autoimmune disorders and medical drugs may also be implicated. Myocarditis has a variable clinical manifestation from latent to very severe clinical forms, such as acute congestive heart failure and sudden death. Scintigraphy, echocardiography and cine magnetic resonance angiography are useful methods to identify myocarditis. Endomyocardial biopsy, using the Dallas criteria for histopathological classification, has remained the gold standard for the diagnosis of acute myocarditis. In this review, pathological mechanisms, modalities of diagnosis and treatment strategies of myocarditis are discussed. Copyright © 2006 by Türkiye Klinikleri

The relationship of platelet-to-lymphocyte ratio with clinical outcome and final infarct core in acute ischemic stroke patients who have undergone endovascular therapy

PubMed ID: 27477691Objectives: Of all strokes, 85% are ischemic and intracranial artery occlusion accounts for 80% of these ischemic strokes. Endovascular therapy for acute ischemic stroke was a new modality aiming at resolution of clots in occluded cerebral arteries. The platelet-to-lymphocyte ratio (PLR) was introduced as a potential marker to determine increased inflammation, which is a result of releasing many mediators from the platelets. In this study we aimed to evaluate whether the PLR had a prognostic role in stroke patients undergoing thrombectomy and attempted to determine the effect that this ratio had on their survival. Methods: Over a three-year period, demographic, clinical, and angiographic findings of 57 consecutive patients with acute ischemic stroke who underwent mechanical thrombectomy were evaluated. Results: The patients were divided into two groups on the basis of a PLR level cut-off value of 145 based on receiver operating characteristic (ROC) curve. Successful revascularization (mTICI 2b and 3) was achieved in 42 of 57 (73.7%) patients; a mTICI 3 state was observed in 21 of 23 patients with low-PLR values (p = .015). Patients with higher PLR values had significantly a score of less than six on the ASPECT scale compared to patients with lower PLR values (p = .005). The patients with low-PLR values had better functional outcomes (mRS ? 2) compared with the patients with high-PLR values [respectively, p = .004 (at first month) and p = .014 (at third month)]. Discussion: The platelet-to-lymphocyte ratio could represent pro-thrombotic inflammatory state in acute ischemic stroke patients because having a high-PLR values increased the poor prognosis, the rate of insufficient recanalization, and the size of infarcted area. © 2016 Informa UK Limited, trading as Taylor & Francis Group

Is there any link between joint hypermobility and mitral valve prolapse in patients with fibromyalgia syndrome?

PubMedID: 26216348The objective of the present study is to determine whether benign joint hypermobility syndrome (BJHS) modifies the risk of mitral valve prolapse (MVP) in patients with fibromyalgia (FM). Female patients fulfilling the 1990 American College of Rheumatology (ACR) diagnostic criteria for FM were included into the study. Joint hypermobility and BJHS were assessed using Beighton’s scoring system and Brighton criteria, respectively. Echocardiograpic evaluation was performed in order to test the presence of MVP. Of the 75 female FM patients, 68.0% (n=51) and 20.0% (n=15) were diagnosed with BJHS and MVP, respectively. The frequencies of both MVP and BJHS seemed higher than the general population prevalence (p=0.000 for both). The frequency of MVP was significantly higher in patients with BJHS than that in patients without BJHS (p=0.028). In addition, BJHS was found to increase the risk of MVP approximately ninefold [odds ratio (OR) 8.7, 95% confidence interval (CI) 1.1–70.7]. As a result, BJHS and MVP are both common in female patients with FM. Moreover, among the female patients with FM, those with BJHS are about nine times more prone to MVP than those without BJHS. Cardiologic assessment might be added to the routine follow-up strategies in FM patients with BJHS in order to exclude the cardiac pathologies, especially MVP. © International League of Associations for Rheumatology (ILAR) 2015

Left ventricular volumes and ejection fraction obtained from 16-frame gated SPECT versus 8-frame gated SPECT in comparison with echocardiography: influence of different processing softwares

WOS: 000208690701173

Compounding uncertainty in Afghanistan : economic consequences of delay in signing the bilateral security Agreement

William A. Byrd; Casey Garret Johnson; Sanaullah Tasa

Association of platelet-to-lymphocyte ratio with silent brain infarcts in patients with paroxysmal atrial fibrillation

PubMed ID: 27456433Objectives: In this study, we aimed to evaluate whether the inflammation as measured by increased platelet to lymphocyte ratio (PLR) predispose to silent infarcts in patients with paroxysmal atrial fibrillation (PAF). Methods: The present study investigated a total of 48 new diagnosed patients with PAF who had no signs of stroke. PLR, which was calculated as the ratio of the platelet count to the lymphocyte count, C-reactive protein and erythrocyte sedimentation rate were measured due to evaluate inflammatory state. Magnetic resonance imaging (MRI) was performed to evaluate the presence of silent brain infarcts (SBIs) in patients. We calculated CHA2DS2–VASc scores for stratifying the stroke risk of patients. Results: Among our study population, the mean age was 56.40 ± 8.99; 36 patients were female. The leading vascular risk factor was hypertension (45.8%). SBI was determined in 16 patients (33.3%) on MRI. It was found that a higher PLR is significantly associated with the presence of SBIs in patients with PAF (P = .001). High PLR group showed silent lesions predominantly multiple, greater than 5 mm, bilateral and in the subcortical region; though no statistically significant differences were found in each lesion areas (P = .214; P = .509; P = .746; P = .059, respectively). Of 16 patients who showed SBI, 1 (6.3%) patient had CHA2DS2–Vasc scores of 0; 7 (43.8%) patients had CHA2DS2–Vasc scores of 1; 6 (37.5%) patients had CHA2DS2 -Vasc scores of 2 and 2 (12.5%) patients had CHA2DS2–Vasc scores of 3. We did not find any significant relationship between CHA2DS2–Vasc scores and presence of SBI in the study patients (P = .850). Discussion: High PLR might be a factor to induce inflammatory process on SBIs even with low CHA2DS2–VASc scores. © 2016 Informa UK Limited, trading as Taylor & Francis Group

Thrombus fragmentation using iliac balloon angioplasty in a patient with massive pulmonary embolism [Masif pulmoner emboli olgusunda iliyak balon anjiyoplasti ile trombüs parçalanmasi]

PubMedID: 18676310[No abstract available