Monocyte to HDL cholesterol ratio predicts obesity-associated cardiac dysfunction

Figure 1. Study flowchart and disease spectrum. A: Flowchart of selecting studied participants. In total, 8848 patients with primary cardiac disease hospitalized in the Department of Cardiology, the First Affiliated Hospital of Nanjing Medical University between 2009 and 2021 were recruited. After excluding individuals with incomplete data and patients with congenital heart disease, a population of 5648 subjects was finally included in the study. B: Pie chart of diagnosed cardiovascular disease types. Data are presented as n (%).

Figure 2. Trends of LVEF and E/A ratio across BMI under the generalized additive model. A: The relationship between LVEF and BMI in 5648 patients with heart disease. Associated R and P values are shown; shaded portions of the figure indicate 95% CI. B: The relationship between E/A and BMI in 5648 patients with heart disease. Associated R and P values are shown; shaded portions of the figure indicate 95% CI. Abbreviations: BMI, body mass index; CI, confidence interval; E/A, early/atrial peak; LVEF, left ventricular ejection fraction.

Figure 3. Correlation between BMI, cardiac function, metabolic, and inflammatory parameters. A: Correlation between HDL-C, LDL-C, TG, TC, MHR, MO, WBC, hs-CRP and BMI in 5648 patients with heart disease. B: Correlation between LVEF and MHR in 5648 patients with heart disease. C: Correlation between E/A ratio and MHR in 5648 patients with heart disease. Associated R and P values are shown; shaded portions of the figure indicate 95% CI. D: Receiver operating characteristic (ROC) curves comparing diagnostic factors for LVEF impairment. Every line represents the diagnostic capability of a specific factor (yellow: baseline; blue: hs-CRP; green: WBC; red: MHR). These factors were analyzed after adjusting for age, sex, smoking, alcohol consumption, hypertension, diabetes, and BMI, which are known risk factors or confounding factors for LVEF impairment. The red line illustrates the improved diagnostic performance achieved when common factors are combined with MHR, yielding a superior area under the curve (AUC) of 0.661, suggesting enhanced diagnostic accuracy. The dashed line represents the line of no discrimination, equivalent to random chance. A DeLong's test of these three correlated ROC curves…

Figure 4. Mediation analysis of BMI elevation and LVEF decline. A: Percentage of mediating effects of elevated BMI on LVEF decline under different mediating measures. ***P < 0.001. B: MHR as a mediator in the LVEF decline caused by elevated BMI, comparison between male and female subgroups. ***P < 0.001. Abbreviations: BMI, body mass index; DE, direct effect; LVEF, left ventricular ejection fraction; HDL-C, high-density lipoprotein cholesterol; hs-CRP, high-sensitivity C-reactive protein; MHR, monocyte to high-density lipoprotein cholesterol ratio; MO, monocyte.