Key result
An admission neutrophil lymphocyte ratio greater than 2.74 predicted the presence of left ventricular apical thrombus with 78% sensitivity and 61% specificity in patients with a large anterior myocardial infarction.
Why the study?
Does the neutrophil lymphocyte ratio predict left ventricular apical thrombus formation in patients with heart failure after a large anterior myocardial infarction?
Case-Control (n=103)
No
Does the neutrophil lymphocyte ratio predict left ventricular apical thrombus formation in patients with heart failure after a large anterior myocardial infarction?
Effect estimate: AUC 0.738 (95% CI 0.642-0.835)
Absolute Event Rate: 78% vs 61%
p-value: p=<0.001
An elevated neutrophil-to-lymphocyte ratio (>2.74) on admission may serve as a useful, independent predictor for the development of left ventricular apical thrombus in patients with reduced ejection fraction following a large anterior myocardial infarction.
May aid early risk stratification for apical thrombus post-anterior MI; leaves open need for prospective validation before changing practice.
BACKGROUND AND OBJECTIVES: In this study, we examined the role of inflammatory parameters in an apical mural thrombus with a reduced ejection fraction due to large anterior myocardial infarction (MI). SUBJECTS AND METHODS: A total of 103 patients who had suffered from heart failure, 45 of whom had left ventricular apical thrombus (AT) after a large anterior MI, were enrolled in the study. A detailed clinical history was taken of each participant, biochemical inflammatory markers, which were obtained during admission, were analyzed and an echocardiographical and angiographical evaluation of specific parameters were performed. RESULTS: There were no statistically significant differences in terms of age, gender, and history of hypertension, diabetes mellitus, and atrial fibrillation between both groups (p>0.05). Similarly there were no statistically significant differences in terms of biochemical and echocardiographic parameters (p>0.05). However, there were significant differences in terms of neutrophil lymphocyte ratio (p=0.032). After a multivariate regression analysis, neutrophil lymphocyte ratio (NLR) was an independent predictor of thrombus formation (β: 0.296, p=0.024). The NLR >2.74 had a 78% sensivity and 61% specifity in predicting thrombus in patients with a low left ventricular ejection fraction. CONCLUSION: In this study, neutrophil lymphocyte ratios were significantly higher in patients with apical thrombus.
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Ertem et al. (2016) conducted a case-control in Left ventricular apical thrombus after large anterior myocardial infarction (n=103). Elevated neutrophil lymphocyte ratio (NLR) vs. Lower neutrophil lymphocyte ratio was evaluated on Prediction of left ventricular apical thrombus (NLR >2.74) (AUC 0.738, 95% CI 0.642-0.835, p=<0.001). An admission neutrophil lymphocyte ratio greater than 2.74 predicted the presence of left ventricular apical thrombus with 78% sensitivity and 61% specificity in patients with a large anterior myocardial infarction.
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