Use of Neutrophil-to-Lymphocyte Ratio and Red Cell Distribution Width as an Adjuvant in Assessing Left Ventricular Systolic Function in Patients with Acute Myocardial Infarction

Abstract

Introduction: Atherosclerosis is a multifactorial disease and the major cause of cardiovascular disease that still accounts for most of the mortality worldwide. The role of inflammation in the development and progression of atherosclerosis has been clarified, and several biological markers of inflammation predict cardiovascular risk. Red cell distribution width (RDW) and neutrophil-to-lymphocyte ratio (NLR) are the two markers of inflammation that are used to determine risk of mortality and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI). Objective: To study the left ventricular systolic function in patients with AMI in relation to neutrophil to-lymphocyte ratio, RDW, and hs-CRP. Materials and Methods: An observational study was done on patients with AMI-ST-elevation myocardial infarction (STEMI) admitted to the hospital. On admission, Electrocardiogram (ECG) was noted, and blood was drawn for a complete hemogram, hs-CRP, cardiac enzymes, and renal function test (RFT). Point of care Echocardiography (ECHO) was obtained along with post-primary percutaneous coronary intervention (PCI) ECHO. Results: In a study involving 100 patients, the mean age was 57.61 ± 13.151 years. The highest number of patients fell in the age group of 61 to 70 years (33%), followed by 51 to 60 years (22%). The study consisted of 76% males. Echocardiography revealed that 9% had normal ejection fraction, 57% had mild left ventricular dysfunction, 22% had moderate dysfunction, and 12% had severe dysfunction. Analysis showed that there is a strong negative correlation between ejection fraction (EF) and NLR (P < 0.001), as well as between EF and RDW (P < 0.001) in patients with STEMI. However, there was no significant correlation between EF and hs-CRP (P = 0.514). Conclusion: Our findings suggest that higher NLR and RDW levels, in patients with first STEMI are associated with higher degree of left ventricular systolic dysfunction.

Keywords

• acute myocardial infarction
• hs-crp
• left ventricular systolic function
• neutrophil-to-lymphocyte ratio and red cell distribution width