White blood cells and neutrophil-to-high density lipoprotein ratio as predictive markers of left ventricular dysfunction in heart failure

BACKGROUND Systemic inflammation, especially of white blood cells (WBCs), is being increasingly accepted as a central mechanism underlying the pathogenesis and development of heart failure (HF). Few studies have assessed their effectiveness as accessible and cost-efficient biomarkers for the early detection of left ventricular dysfunction, as well as their potential predictive value in patients with coronary artery disease (CAD). AIM To explore the correlation between WBC parameters and low left ventricular ejection fraction (LVEF) in HF patients and to evaluate its predictive potential. METHODS Two-hundred patients with angiographically proven CAD were enrolled in the study. Lymphocyte and neutrophil counts were measured in an automated analyzer. The number of neutrophils was divided by serum level of high density lipoprotein (HDL) to obtain the neutrophil-to-HDL ratio (NHR). Regression analysis was used to examine correlations, and receiver operating characteristic curve analysis was employed to identify predictive value of these hematological markers. RESULTS WBC, neutrophils, lymphocytes, and NHR are significantly higher among HF patients with low LVEF. Regression analysis revealed a negative association between LVEF and WBC (r 2 = 0.007), neutrophils (r 2 = 0.019), lymphocytes (r 2 = 0.089), and the NHR (r 2 = 0.013). ROC analysis revealed that the AUC for WBC was 0.61, with a sensitivity of 72% and specificity of 60%, while neutrophils showed the same AUC (0.61) but with 56% sensitivity and 60% specificity. Lymphocytes showed a higher AUC of 0.68 (72% sensitivity, 60% specificity), while NHR had the lowest AUC at 0.59 (65% sensitivity, 52% specificity). CONCLUSION These data indicate that parameters of WBCs, notably lymphocytes, neutrophils, and NHR, can act as useful biomarkers for detection of decreased LVEF in patients with HF. These findings suggest that neutrophils, lymphocytes, and NHR are not only routinely available and cost-effective markers but may also serve as early predictors of reduced LVEF in CAD patients, offering potential utility in clinical risk stratification and management. Further research is needed to validate these findings and explore their potential as clinical risk markers and therapeutic targets in CAD with HF.