A Descriptive Study to Correlate NLR with Left Ventricular Systolic Function after ACS

Background: Cardiovascular diseases (CVDs) are responsible for 32% of all deaths worldwide and are the number one cause of deaths globally not only in high-income countries but also in low- and-middle-income nations. Recently, neutrophil/lymphocyte ratio (NLR) has been was found to be a strong predictor of adverse outcomes after Acute coronary syndromes (ACS). The possible mechanism is inflammation associated with atherosclerosis and its acute manifestation. This ratio can be accessed easily and is inexpensive. However, the prognostic value of NLR over and above the traditional cardiac biomarkers is unknown. Aims and Objectives: The aim of study was to evaluate the prognostic role of NLR in patients with ACS. To correlate NLR with existing ACS cardiac biomarkers and evaluate incremental value of NLR for predicting adverse clinical outcomes after ACS over traditional markers. To correlate NLR with ST segment score in ST elevation MI (STEMI) and with left ventricular systolic function after ACS. Methodology: A total of 100 consecutive ACS patients were included in the study after screening for inclusion and exclusion criteria. Informed consent was taken from the patient. Besides the demographic history, cardiac risk factors, clinical presentation and diagnosis were noted for all. NLR calculated as total neutrophil count divided by total lymphocyte count was computed for all included patients. An assessment of the inflammatory markers like LDH and cardiac function parameters like CPK, CK-MB was done. All patients underwent 2D echocardiography by an experienced cardiologists and left ventricular ejection fraction (LVEF) was assessed for all. ST segment score was noted for patients with STEMI. Results: NLR was positively corelated (significant statistically) with total leucocyte count (TLC) (r = 0.28), AST (r = 0.37), LDH (r = 0.46), CK-MB (r = 0.35), CPK (r = 0.46) and ST segment score (r=0.56). The P values for these correlations were <0.05. NLR co-related negatively LVEF (r = -0.26) (p < 0.05). NLR was positively corelated with mortality status with a rho level of 0.27 suggestive of a moderate positive association between the two parameters. As the outcome status changed from survival to mortality, the NLR ratio was seen to increase. The results were significant statistically (P=0.0058). There was no significant correlation of the NLR ratio with the gender or comorbidity related predictors. Interpretation and Conclusions: This study concludes that the NLR is a good predictor for myocardial damage as well as impaired cardiac contractility. The NLR can help in early prognostication of ACS severity as well and help initiate treatment therapies to prevent adverse outcomes like mortality. Its role in predicting adverse clinical outcomes can be utilized in improving the management protocols in cardiology units. The findings of our study are in accordance with the published national and international literature in this domain. We have limited Indian studies on this domain and our study adds to the limited pool of literature concerning NLR role in ACS outcome and severity prediction. Larger randomized trials with multicentric study designs need to be conducted to further validate the findings in this study. Incorporation of NLR as an early bedside investigation in risk stratification of the patients also needs to be explored further.