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BMC Cardiovascular Disorders

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Open Access 01-12-2021 | Research article

Association of the lymphocyte-to-monocyte ratio, mean diameter of coronary arteries, and uric acid level with coronary slow flow in isolated coronary artery ectasia

Authors: Zhuoxuan Yang, Jiansong Yuan, JinGang Cui, Hao Guan, Shubin Qiao

Published in: BMC Cardiovascular Disorders | Issue 1/2021

Abstract

Background

The pathophysiology of isolated coronary artery ectasia (CAE) with the coronary slow flow (CSF) phenomenon is still unclear. The purpose of this study was to investigate the risk factors for isolated CAE complicated with CSF.

Methods

A total of 126 patients with isolated CAE were selected retrospectively. The patients were grouped into the no CSF (NCSF) group (n = 55) and the CSF group (n = 71) according to the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). Data on demographics, laboratory measurements, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), CTFC and diameters of three coronary arteries were collected.

Results

The proportions of males (84.5% vs. 61.8%, p = 0.004) and patients with a smoking history (63.4% vs. 43.6%, p = 0.021) were higher in the CSF group than in the NCSF group. The neutrophil-to-lymphocyte ratio (NLR) (2.08(1.68–3.21) vs. 1.89 ± 0.58, p = 0.001), mean diameter of coronary arteries (mean D) (5.50 ± 0.85 vs. 5.18 ± 0.91, p < 0.001), and uric acid (URIC) level (370.78 ± 109.79 vs. 329.15 ± 79.71, p = 0.019) were significantly higher in the CSF group, while the lymphocyte-to-monocyte ratio (LMR) (4.81 ± 1.66 vs. 5.96 ± 1.75, p < 0.001) and albumin (ALB) level (44.13 ± 4.10 vs. 45.69 ± 4.11, p = 0.036) were lower. Multivariable logistic analysis showed that the LMR (odds ratio: 0.614, 95% CI: 0.464–0.814, p = 0.001), mean D (odds ratio: 2.643, 95% CI: 1.54–4.51, p < 0.001) and URIC level (odds ratio: 1.006, 95% CI: 1.001–1.012, p = 0.018) were independent predictors of CSF in CAE.

Conclusions

The LMR was a negative independent predictor of CSF in isolated CAE, while URIC level and mean D were positive independent predictors.

Isik T, Ayhan E, Uyarel H, Tanboga IH, Kurt M, Uluganyan M, Ergelen M, Eksik A. Association of neutrophil to lymphocyte ratio with presence of isolated coronary artery ectasia. Turk Kardiyol Dern Ars. 2013;41(2):123–30. https://doi.org/10.5543/tkda.2013.17003.CrossRefPubMed

Ozkan B, Orscelik O, Yildirim Yaroglu H, Balci S, Ozcan MK, Celik A, Ozcan IT. Association between serum adropin levels and isolated coronary artery ectasia in patients with stable angina pectoris. Anatol J Cardiol. 2019;22(5):250–5. https://doi.org/10.14744/AnatolJCardiol.2019.90349.CrossRefPubMedPubMedCentral

Sen N, Ozcan F, Uygur B, Aksu T, Akpinar I, Cay S, Cetin M, Sokmen E, Akcakoyun M, Maden O, Balbay Y, Erbay AR. Elevated serum uric acid levels in patients with isolated coronary artery ectasia. Turk Kardiyol Dern Ars. 2009;37(7):467–72.PubMed

Hartnell GG, Parnell BM, Pridie RB.Coronary artery ectasia. Its prevalence and clinical signifificance in 4,993 patients.Br Heart J.1985;54(4):392–395.

Hawkins BM, Stavrakis S, Rousan TA, Abu-Fadel M, Schechter E. Coronary slow flow–prevalence and clinical correlations. Circ J. 2012;76(4):936–42. https://doi.org/10.1253/circj.cj-11-0959.CrossRefPubMed

Yayla C, Akboga MK, Gayretli Yayla K, Ertem AG, Efe TH, Sen F, Unal S, Acar B, Ozcan F, Turak O, Ozeke O. A novel marker of inflammation in patients with slow coronary flow: lymphocyte-to-monocyte ratio. Biomark Med. 2016;10(5):485–93. https://doi.org/10.2217/bmm-2016-0022.CrossRefPubMed

Demirci E, Elik O, Kalk M, Lütfü Bekar Yetim M, Doan T (2019) Evaluation of homocystein and asymmetric dimethyl arginine levels in patients with coronary slow flow phenomenon. Interv Med Appl Sci 11: 2. https://doi.org/10.1556/1646.11.2019.07

Cetin M, Zencir C, Tasolar H, Baysal E, Balli M, Akturk E. The association of serum albumin with coronary slow flow. Wien Klin Wochenschr. 2014;126(15–16):468–73. https://doi.org/10.1007/s00508-014-0559-8.CrossRefPubMed

Kalyoncuoglu M, Biter HI, Ozturk S, Belen E, Can MM. Predictive accuracy of lymphocyte-to-monocyte ratio and monocyte-to-high-density-lipoprotein-cholesterol ratio in determining the slow flow/no-reflow phenomenon in patients with non-ST-elevated myocardial infarction. Coron Artery Dis. 2020;31(6):518–26. https://doi.org/10.1097/MCA.0000000000000848.CrossRefPubMed

10.

Kurtul A, Yarlioglues M, Celik IE, Duran M, Elcik D, Kilic A, Oksuz F, Murat SN. Association of lymphocyte-to-monocyte ratio with the no-reflow phenomenon in patients who underwent a primary percutaneous coronary intervention for ST-elevation myocardial infarction. Coron Artery Dis. 2015;26(8):706–12. https://doi.org/10.1097/MCA.0000000000000301.CrossRefPubMed

11.

Yilmaz M, Korkmaz H, Bilen MN, Uku O, Kurtoglu E. Could neutrophil/lymphocyte ratio be an indicator of coronary artery disease, coronary artery ectasia and coronary slow flow? J Int Med Res. 2016;44(6):1443–53. https://doi.org/10.1177/0300060516664637.CrossRefPubMedPubMedCentral

12.

Demir S, Karakoyun G, Kanadasi M. Elevated high sensitivity C-reactive protein and uric acid levels in coronary artery ectasia. Acta Biochim Pol. 2014;61(4):687–91.CrossRef

13.

Gibson CM, Cannon CP, Daley WL, Dodge JT Jr, Alexander B Jr, Marble SJ, et al. TIMI frame count: a quantitative method of assessing coronary artery flow. Circulation. 1996;93:879–88.CrossRef

14.

Mukhopadhyay S, Kumar M, Yusuf J, Gupta VK, Tyagi S. Risk factors and angiographic profile of coronary slow flow (CSF) phenomenon in North Indian population: an observational study. Indian Heart J. 2018;70(3):405–9. https://doi.org/10.1016/j.ihj.2017.09.001.CrossRefPubMed

15.

Brunetti ND, Salvemini G, Cuculo A, Ruggiero A, De Gennaro L, Gaglione A, Di Biase M. Coronary artery ectasia is related to coronary slow flow and inflammatory activation. Atherosclerosis. 2014;233(2):636–40. https://doi.org/10.1016/j.atherosclerosis.2014.01.018.CrossRefPubMed

16.

Yildirim N, Tekin IO, Dogan SM, Aydin M, Gursurer M, Cam F, Gungorduk A, Akoz A. Expression of monocyte and lymphocyte adhesion molecules is increased in isolated coronary artery ectasia. Coron Artery Dis. 2007;18(1):49–53. https://doi.org/10.1097/MCA.0b013e32801104d4.CrossRefPubMed

17.

Gong S, Gao X, Xu F, Shang Z, Li S, Chen W, Yang J, Li J. Association of lymphocyte to monocyte ratio with severity of coronary artery disease. Medicine (Baltimore). 2018;97(43):e12813. https://doi.org/10.1097/MD.0000000000012813.CrossRef

18.

Kose N, Akin F, Yildirim T, Ergun G, Altun I. The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease. Eur Rev Med Pharmacol Sci. 2019;23(6):2570–5. https://doi.org/10.26355/eurrev_201903_17406.CrossRefPubMed

19.

Kiris T, Celik A, Varis E, Akan E, Akyildiz ZI, Karaca M, Nazli C, Dogan A. Association of lymphocyte-to-monocyte ratio with the mortality in patients with ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Angiology. 2017;68(8):707–15. https://doi.org/10.1177/0003319716685480.CrossRefPubMed

20.

Si Y, Liu J, Shan W, Zhang Y, Han C, Wang R, Sun L. Association of lymphocyte-to-monocyte ratio with total coronary plaque burden in patients with coronary artery disease. Coron Artery Dis. 2020;31(7):650–5. https://doi.org/10.1097/MCA.0000000000000857.CrossRefPubMedPubMedCentral

21.

Wang Q, Ma J, Jiang Z, Wu F, Ping J, Ming L. Association of lymphocyte-to-monocyte ratio with in-hospital and long-term major adverse cardiac and cerebrovascular events in patients with ST-elevated myocardial infarction. Medicine (Baltimore). 2017;96(34):e7897. https://doi.org/10.1097/MD.0000000000007897.CrossRef

22.

Tan D, Fu Y, Tong W, Li F. Prognostic significance of lymphocyte to monocyte ratio in colorectal cancer: a meta-analysis. Int J Surg. 2018 Jul;55:128–38. https://doi.org/10.1016/j.ijsu.2018.05.030.CrossRefPubMed

23.

Pan YC, Jia ZF, Cao DH, Wu YH, Jiang J, Wen SM, Zhao D, Zhang SL, Cao XY. Preoperative lymphocyte-to-monocyte ratio (LMR) could independently predict overall survival of resectable gastric cancer patients. Medicine (Baltimore). 2018 Dec;97(52):e13896.CrossRef

24.

Quan XQ, Wang RC, Zhang Q, Zhang CT, Sun L. The predictive value of lymphocyte-to-monocyte ratio in the prognosis of acute coronary syndrome patients: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2020;20(1):338. https://doi.org/10.1186/s12872-020-01614-x.CrossRefPubMedPubMedCentral

25.

Mandurino-Mirizzi A, et al. Serum uric acid may modulate the inflammatory response after primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction. J Cardiovasc Med (Hagerstown). 2020 Apr;21(4):337–9. https://doi.org/10.2459/JCM.0000000000000926.CrossRef

26.

Mandurino-Mirizzi A, Crimi G, Raineri C, Pica S, Ruffinazzi M, Gianni U, Repetto A, Ferlini M, Marinoni B, Leonardi S, De Servi S, Oltrona Visconti L, De Ferrari GM, Ferrario M. Elevated serum uric acid affects myocardial reperfusion and infarct size in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown). 2018;19(5):240–6. https://doi.org/10.2459/JCM.0000000000000634.CrossRef

27.

Magnoni M, Berteotti M, Ceriotti F, Mallia V, Vergani V, Peretto G, Angeloni G, Cristell N, Maseri A, Cianflone D. Serum uric acid on admission predicts in-hospital mortality in patients with acute coronary syndrome. Int J Cardiol. 2017;240:25–9. https://doi.org/10.1016/j.ijcard.2017.04.027.CrossRefPubMed

28.

Kang DH, Han L, Ouyang X, Kahn AM, Kanellis J, Li P, Feng L, Nakagawa T, Watanabe S, Hosoyamada M, Endou H, Lipkowitz M, Abramson R, Mu W, Johnson RJ. Uric acid causes vascular smooth muscle cell proliferation by entering cells via a functional urate transporter. Am J Nephrol. 2005;25(5):425–33. https://doi.org/10.1159/000087713.CrossRefPubMed

29.

Kanbay M, Segal M, Afsar B, Kang DH, Rodriguez-Iturbe B, Johnson RJ. The role of uric acid in the pathogenesis of human cardiovascular disease. Heart. 2013;99(11):759–66. https://doi.org/10.1136/heartjnl-2012-302535.CrossRefPubMed

30.

Kanellis J, Watanabe S, Li JH, Kang DH, Li P, Nakagawa T, Wamsley A, Sheikh-Hamad D, Lan HY, Feng L, Johnson RJ. Uric acid stimulates monocyte chemoattractant protein-1 production in vascular smooth muscle cells via mitogen-activated protein kinase and cyclooxygenase-2. Hypertension. 2003;41(6):1287–93. https://doi.org/10.1161/01.HYP.0000072820.07472.3B.CrossRefPubMed

31.

Somaschini A, et al. Neutrophil to platelet ratio: A novel prognostic biomarker in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Eur J Prev Cardiol. 2019 Dec 16. https://doi.org/10.1177/2047487319894103.CrossRefPubMed

32.

Weilei, Yiting, Ruan, et al. High neutrophil-to-platelet ratio is associated with hemorrhagic transformation in patients with acute ischemic stroke. Front Neurol, 2019, 10:1310–1310. https://doi.org/10.3389/fneur.2019.01310

33.

Wei XB, Liu YH, He PC, et al. The impact of admission neutrophil-to-platelet ratio on in-hospital and long-term mortality in patients with infective endocarditis. Clin Chem Lab Med (CCLM). 2017. https://doi.org/10.1515/cclm-2016-0527.CrossRef

34.

Liu R, Chen L, Wu W, Chen H, Zhang S. Extracellular matrix turnover in coronary artery ectasia patients. Heart Vessels. 2016 Mar;31(3):351–9. https://doi.org/10.1007/s00380-014-0622-4.CrossRefPubMed

35.

Dahi S, Karliner JS, Sarkar R, Lovett DH. Transgenic expression of matrix metalloproteinase-2 induces coronary artery ectasia. Int J Exp Pathol. 2011 Feb;92(1):50–6. https://doi.org/10.1111/j.1365-2613.2010.00744.x.

Title: Association of the lymphocyte-to-monocyte ratio, mean diameter of coronary arteries, and uric acid level with coronary slow flow in isolated coronary artery ectasia
Authors: Zhuoxuan Yang
Jiansong Yuan
JinGang Cui
Hao Guan
Shubin Qiao
Publication date: 01-12-2021
Publisher: BioMed Central
Published in: BMC Cardiovascular Disorders / Issue 1/2021
Electronic ISSN: 1471-2261
DOI: https://doi.org/10.1186/s12872-021-01952-4

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Abstract

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