Aortic Stiffness and Neutrophil-to-Lymphocyte Ratio as a Non-Invasive Predictor of Acute Coronary Artery Stenosis Presence and Severity

Background: Aortic stiffness is a primary indicator of structural and functional arterial degradation. It is closely linked to atherosclerosis inflammatory, lipid-driven occlusive disease and an elevated neutrophil-to-lymphocyte ratio (NLR). The aim is to evaluate the utility of the aortic stiffness index (ASI) and NLR in predicting the presence and severity of acute coronary syndrome (ACS) Methods: This cross-sectional study analyzed 92 patients undergoing coronary angiography at Zagazig University Hospitals' Cardiology Department. Transthoracic M-mode echocardiography (parasternal long-axis view, 3 cm above the aortic valve) was used to measure ascending aorta diameters at maximal anterior motion (systole) and the QRS complex onset (diastole). The NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte count from peripheral blood samples. Results: ASI demonstrated high diagnostic accuracy for ACS, yielding a sensitivity of 90% and specificity of 100% at a cutoff >8.46 mm. All measured aortic stiffness markers effectively identified ACS patients. Conversely, aortic distensibility showed a sensitivity of 91.67% and specificity of 93.75% at a cutoff <2.10 mm. Conclusions: Conventional M-mode echocardiography serves as an effective, non-invasive tool for predicting ACS presence and severity. Furthermore, a high NLR independently predicts both the occurrence and severity of aortic stiffness.