Turkiye Klinikleri Journal of Medical Sciences

.: ORIGINAL RESEARCH
Sol Ventrikülün Yeniden Şekillenme Tipleri ile İnflamatuar Belirteçleri Arasındaki İlişki
The Relationship Between Left Ventricle Remodelling Types and Inflammatory Markers
Ömer KÜMETa, Berat ENGİNb, Remzi SARIKAYAa, Semih SÜRMENc, İmran ÖNÜRd, Dursun ATILGANc
aSağlık Bilimleri Üniversitesi Van Bölge Eğitim ve Araştırma Hastanesi, Kardiyoloji ABD, Van, TÜRKİYE
bManavgat Devlet Hastanesi, Kardiyoloji Kliniği, Antalya, TÜRKİYE
cİstanbul Üniversitesi Tıp Fakültesi, Kardiyoloji ABD, İstanbul, TÜRKİYE
dMemorial Bahçelievler Hastanesi, Kardiyoloji Kliniği, Van, TÜRKİYE
Turkiye Klinikleri J Med Sci. 2021;41(3):266-73
doi: 10.5336/medsci.2021-82586
Article Language: TR
Full Text
ÖZET
Amaç: Birçok kardiyovasküler hastalıkta, prognoz belirleyici ve risk faktörü olarak inflamatuar biyobelirteçler gösterilmiş. Bu çalışmamızda, Nötrofil/Lenfosit oranı (NLO), Platelet/Lenfosit oranı (PLO) ve yüksek duyarlılıklı-C-reaktif proteinin [high sensitivity-C-reactive protein (hs-CRP)] sol ventrikül yeniden şekillenme ile ilişkisi araştırılmıştır. Gereç ve Yöntemler: Bu çalışmaya, İstanbul Üniversitesi Tıp Fakültesi Kardiyoloji polikliniğine başvuran 122 hasta dâhil edilmiştir. Tüm hastalardan 12 saatlik açlık sonrası kan örnekleri alınmış olup, ekokardiyografik değerlendirmeler sonrası hastalar erkek ve kadın farkı gözetilerek normal geometri, konsantrik sol ventrikül hipertrofisi (SVH), eksantrik SVH ve konsantrik yeniden şekillenme (KYŞ) olmak üzere 4 gruba ayrıldı. Bulgular: Bu çalışmadaki 30 kişi, ekokardiyografide sol ventrikül fonksiyonları ve geometrisi normal olan kontrol grubuydu. Otuz hastada konsantrik SVH, 30 kişide eksantrik SVH ve 32 kişide KYŞ mevcuttu. Sol ventrikül geometrisi değişmiş tüm hastalarda, nötrofil değerleri normallere göre anlamlı olarak artmıştı. Ayrıca bu hasta gruplarında hs-CRP ve NLO düzeyleri normal geometrisi olanlara göre daha yüksekti ancak bu fark sadece NLO'da istatistiksel olarak anlamlı olma eğilimindeydi (p=0,05). Bu fark özellikle eksantrik SVH'ye sahip hasta grubunda daha belirgindi. PLO değeri ise tüm hasta gruplarında anlamlı farklılık göstermedi. Sonuç: Çalışmamızda, NLO parametresi, sol ventrikül remodeling geçiren tüm hastalarda normale göre daha yüksektir. Hs-CRP düzeyleri ise özellikle KYŞ alt grubunda olmak üzere tüm gruplarda normal geometriye sahip, kontrol grubuna göre daha yüksek saptanmıştır.

Anahtar Kelimeler: Sol ventrikül hipertrofisi; inflamasyon; inflamatuar biyobelirteçler
ABSTRACT
Objective: Inflammatory markers have been shown as prognostic and risk factors in many cardiovascular diseases. In this study, the relationship between Neutrophil/Lymphocyte ratio (NLR), Platelet/Lymphocyte ratio (PLO) and high sensitivity-C-reactive protein (hs-CRP) with left ventricular remodeling was investigated. Material and Methods: This study included 122 patients who applied to the İstanbul University Faculty of Medicine Cardiology outpatient clinic. Blood samples were taken from all patients after 12 hours of fasting, and after echocardiographic evaluations, the patients were divided into 4 groups as normal geometry, concentric left ventricular hypertrophy (LVH), eccentric LVH and concentric remodeling, taking into account the difference between men and women. Results: The 30 subjects in this study were the control group with normal left ventricular functions and geometry on echocardiography. Thirty patients had concentric LVH, 30 patients had eccentric LVH, and 32 patients had concentric remodeling. Neutrophil values were significantly increased in all patients with altered left ventricular geometry compared to normal. In addition, hs-CRP and NLR levels were higher in these patient groups than those with normal geometry, but this difference tended to be statistically significant only in the NLR (p=0.05). This difference was more pronounced in the patient group with eccentric LVH. PLO value did not differ significantly in all patient groups. Conclusion: In our study, the NLR parameter is higher than normal in all patients with left ventricular remodeling. Hs-CRP levels were higher in all groups than the control group with normal geometry, especially in the concentric remodeling subgroup.

Keywords: Left ventricular hypertrophy; inflammation; inflammatory biomarkers
REFERENCES:
  1. Levy D, Garrison RJ, Savage DD, Kannel WB, Castelli WP. Prognostic implications of echocardiographically determined left ventricular mass in the Framingham Heart Study. N Engl J Med. 1990;322(22):1561-6. [Crossref] [PubMed] 
  2. Koren MJ, Devereux RB, Casale PN, Savage DD, Laragh JH. Relation of left ventricular mass and geometry to morbidity and mortality in uncomplicated essential hypertension. Ann Intern Med. 1991;114(5):345-52. [Crossref] [PubMed] 
  3. Jennings G, Wong J. Reversibility of left ventricular hypertrophy and malfunction by antihypertensy treatment. In: Hansson L, Birkenhager WH, editörler. Handbook of Hypertension. Vol 18. Amsterdam: Elsevier Science; 1997. p.184-223. [Link] 
  4. Polese A, De Cesare N, Montorsi P, Fabbiocchi F, Guazzi M, Loaldi A, et al. Upward shift of the lower range of coronary flow autoregulation in hypertensive patients with hypertrophy of the left ventricle. Circulation. 1991;83:845-53. [Crossref] [PubMed] 
  5. Norton GR, Woodiwiss AJ, Gaasch WH, Mela T, Chung ES, Aurigemma GP, et al. Heart failure in pressure overload hypertrophy. The relative roles of ventricular remodeling and myocardial dysfunction. J Am Coll Cardiol. 2002;39(4):664-71. [Crossref] [PubMed] 
  6. Fredj S, Bescond J, Louault C, Delwail A, Lecron JC, Potreau D. Role of interleukin-6 in cardiomyocyte/cardiac fibroblast interactions during myocyte hypertrophy and fibroblast proliferation. J Cell Physiol. 2005;204(2):428-36. [Crossref] [PubMed] 
  7. Yokoyama T, Nakano M, Bednarczyk JL, McIntyre BW, Entman M, Mann DL. Tumor necrosis factor-alpha provokes a hypertrophic growth response in adult cardiac myocytes. Circulation. 1997;95(5):1247-52. [Crossref] [PubMed] 
  8. Ates AH, Canpolat U, Yorgun H, Kaya EB, Sunman H, Demiri E, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dual-source multislice computed tomographic coronary angiography. Cardiol J. 2011;18(4):371-7. [PubMed] 
  9. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation. 2003;108(24):3006-10. [Crossref] [PubMed] 
  10. Buckley DI, Fu R, Freeman M, Rogers K, Helfand M. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U.S. Preventive Services Task Force. Ann Intern Med. 2009;151(7):483-95. [Crossref] [PubMed] 
  11. Danesh J, Collins R, Appleby P, Peto R. Association of fibrinogen, C-reactive protein, albumin, or leukocyte count with coronary heart disease: meta-analyses of prospective studies. JAMA. 1998;279(18):1477-82. [Crossref] [PubMed] 
  12. Seyfeli E, Sarli B, Saglam H, Karatas CY, Ozkan E, Ugurlu M. The relationship between high-sensitivity c-reactive protein levels and left ventricular hypertrophy in patients with newly diagnosed hypertension. J Clin Hypertens (Greenwich). 2016;18(7):679-84. [Crossref] [PubMed] 
  13. Monfared A, Salari A, Kazemnezhad E, Lebadi M, Khosravi M, Mehrjardi NK, et al. Association of left ventricular hypertrophy with high-sensitive C-reactive protein in hemodialysis patients. Int Urol Nephrol. 2013;45(6):1679-86. [Crossref] [PubMed] 
  14. Kim KI, Lee JH, Chang HJ, Cho YS, Youn TJ, Chung WY, et al. Association between blood pressure variability and inflammatory marker in hypertensive patients. Circ J. 2008;72(2):293-8. [Crossref] [PubMed] 
  15. Olsen MH, Christensen MK, Hansen TW, Gustafsson F, Rasmussen S, Wachtell K, et al. High-sensitivity C-reactive protein is only weakly related to cardiovascular damage after adjustment for traditional cardiovascular risk factors. J Hypertens. 2006;24(4):655-61. [Crossref] [PubMed] 
  16. Conen D, Zeller A, Pfisterer M, Martina B. Usefulness of B-type natriuretic peptide and C-reactive protein in predicting the presence or absence of left ventricular hypertrophy in patients with systemic hypertension. Am J Cardiol. 2006;97(2):249-52. [Crossref] [PubMed] 
  17. Rutter MK, Meigs JB, Sullivan LM, D'Agostino RB Sr, Wilson PW. C-reactive protein, the metabolic syndrome, and prediction of cardiovascular events in the Framingham Offspring Study. Circulation. 2004;110(4):380-5. [Crossref] [PubMed] 
  18. Schillaci G, Pirro M, Gemelli F, Pasqualini L, Vaudo G, Marchesi S, et al. Increased C-reactive protein concentrations in never-treated hypertension: the role of systolic and pulse pressures. J Hypertens. 2003;21(10):1841-6. [Crossref] [PubMed] 
  19. Ridker PM. High-sensitivity C-reactive protein: potential adjunct for global risk assessment in the primary prevention of cardiovascular disease. Circulation. 2001;103(13):1813-8. [Crossref] [PubMed] 
  20. Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M, et al; Centers for Disease Control and Prevention; American Heart Association. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003;107(3):499-511. [Crossref] [PubMed] 
  21. Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil-lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta. 2008;395(1-2):27-31. [Crossref] [PubMed] 
  22. Açar G, Fidan S, Uslu ZA, Turkday S, Avci A, Alizade E, et al. Relationship of neutrophil-lymphocyte ratio with the presence, severity, and extent of coronary atherosclerosis detected by coronary computed tomography angiography. Angiology. 2015;66(2):174-9. [Crossref] [PubMed] 
  23. Aygün F, Efe D. Association of neutrophil/lymphocyte ratio with obstructive coronary artery disease and coronary artery calcium score detected by multislice computed tomography in type 2 diabetes mellitus patients. Patient Prefer Adherence. 2015;9:1023-31. [Crossref] [PubMed] [PMC] 
  24. Arruda-Olson AM, Reeder GS, Bell MR, Weston SA, Roger VL. Neutrophilia predicts death and heart failure after myocardial infarction: a community-based study. Circ Cardiovasc Qual Outcomes. 2009;2(6):656-62. [Crossref] [PubMed] 
  25. Gibson PH, Croal BL, Cuthbertson BH, Small GR, Ifezulike AI, Gibson G, et al. Preoperative neutrophil-lymphocyte ratio and outcome from coronary artery bypass grafting. Am Heart J. 2007;154(5):995-1002. [Crossref] [PubMed] 
  26. Gibson PH, Cuthbertson BH, Croal BL, Rae D, El-Shafei H, Gibson G, et al. Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol. 2010;105(2):186-91. [Crossref] [PubMed] 
  27. Li H, Zhou Y, Ma Y, Han S, Zhou L. The prognostic value of the platelet-to-lymphocyte ratio in acute coronary syndrome: a systematic review and meta-analysis. Kardiol Pol. 2017;75(7):666-73. [Crossref] [PubMed] 
  28. Gungor H, Babu AS, Zencir C, Akpek M, Selvi M, Erkan MH, et al. Association of preoperative platelet-to-lymphocyte ratio with atrial fibrillation after coronary artery bypass graft surgery. Med Princ Pract. 2017;26(2):164-8. [Crossref] [PubMed] [PMC] 
  29. Ozcan Cetin EH, Cetin MS, Canpolat U, Akdi A, Aras D, Temizhan A, et al. Platelet-to-lymphocyte ratio as a novel marker of in-hospital and long-term adverse outcomes among patients with acute pulmonary embolism: A single center large-scale study. Thromb Res. 2017;150:33-40. [Crossref] [PubMed] 
  30. Du R, Li D, Yu J, Ma Y, Zhang Q, Zeng Z, et al. Association of platelet to lymphocyte ratio and risk of in-hospital mortality in patients with type B acute aortic dissection. Am J Emerg Med. 2017;35(2):368-70. [Crossref] [PubMed] 
  31. Belen E, Özal E, Püsüroğlu H. Relationship between the presence of left atrial thrombus in patients with mitral stenosis and platelet-to-lymphocyte ratio. Anatol J Cardiol. 2016;16(9):673-7. [PubMed] [PMC] 
  32. Gupta J, Dominic EA, Fink JC, Ojo AO, Barrows IR, Reilly MP, et al; CRIC Study Investigators. Association between Inflammation and Cardiac Geometry in Chronic Kidney Disease: Findings from the CRIC Study. PLoS One. 2015;10(4):e0124772. [Crossref] [PubMed] [PMC] 
  33. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1-39.e14. [Crossref] [PubMed] 
  34. Mosteller RD. Simplified calculation of body-surface area. N Engl J Med. 1987;317(17):1098. [Crossref] [PubMed] 
  35. Masiha S, Sundström J, Lind L. Inflammatory markers are associated with left ventricular hypertrophy and diastolic dysfunction in a population-based sample of elderly men and women. J Hum Hypertens. 2013;27(1):13-7. [Crossref] [PubMed] 

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