Neutrophil-to-Lymphocyte Ratio and its Relation with Myocardial Markers and Varying Severity of Myocardial Ischemia on Lexiscan in High-Risk Patients

Background: Coronary artery disease is mainly caused by atherosclerosis that is considered an immune-inflammatory condition. The neutrophil-to-lymphocyte ratio (NLR) is a widely available inflammatory biomarker that has been found a very useful marker in acute coronary syndrome. Objectives: The aim of this study was to check the utility of NLR inflammatory biomarkers with varying severities of myocardial ischemia and to correlate it with cardiac troponin elevation and abnormal myocardial stress imaging patterns. Methods: All patients with anginal chest pain or angina equivalents who underwent regadenoson single-photon emission computed tomography myocardial perfusion imaging, commonly known as Lexiscan, with positive stress results, defined as reversible myocardial ischemia were included. The corresponding NLRs, cardiac troponins, and stress imaging parameters were reviewed. Results: A total of 92 patients were studied. There was no statistically significant difference in the elevation of NLR inflammatory biomarker across varying severities of myocardial ischemic categories but NLR correlated positively with the cardiac troponin T (cTnT) elevation. cTnT elevation was significantly associated with the severity of myocardial ischemia ( P < 0.05). The intertertile NLR comparison revealed an inversely proportional relationship of stress left ventricular ejection fraction with NLR ( P < 0.01). Conclusion: NLR is not influenced by the severity of myocardial ischemia, but correlates positively with cTnT elevation. The high NLR translates into more depressed left ventricular function on stress testing.