Differential value of the neutrophil-to-lymphocyte ratio in assessing right ventricular function and prognosis in patients with chronic pulmonary heart disease and those with concomitant coronary artery disease

To investigate the differential predictive value of the neutrophil-to-lymphocyte ratio (NLR) for right ventricular dysfunction and adverse prognosis in patients with chronic pulmonary heart disease (CPHD) and those with CPHD combined with coronary atherosclerotic heart artery disease (CAD). A retrospective analysis was conducted on clinical data from 289 patients at Qinghai Provincial Communications Hospital. Patients were divided into three groups: CPHD group ( n = 102), CAD group ( n = 90), and CPHD + CAD group ( n = 97). Pearson correlation analysis was used to assess the relationship between NLR and right ventricular function parameters. Receiver Operating Characteristic (ROC) curves were employed to evaluate the predictive efficacy of NLR for right ventricular dysfunction and 6-month adverse prognosis. Cox regression was performed to identify independent risk factors for adverse prognosis in each group. NLR levels were significantly higher in the CPHD + CAD group than in the CPHD and CAD groups ( P < 0.05). Correlation analysis showed that in the CPHD group, NLR was negatively correlated with tricuspid annular plane systolic excursion (TAPSE), right ventricular fractional area change (RVFAC), and inferior vena cava (IVC) variability, and strongly positively correlated with right ventricular free wall longitudinal strain (RVFWLS), right ventricular diameter (RVD), right atrial area (RAA), pulmonary artery systolic pressure (PASP), IVC diameter, and N-terminal pro-brain natriuretic peptide (NT-proBNP) ( P < 0.001). These correlations were even stronger in the CPHD + CAD group ( P < 0.001). ROC curve analysis indicated that NLR had significant predictive value for the primary composite endpoint in the CPHD + CAD group (area under the curve [AUC] = 0.879), followed by the CPHD group (AUC = 0.789), and the poorest in the CAD group (AUC = 0.638). After adjusting for LVEF, Cox regression confirmed that NLR remained an independent risk factor for adverse prognosis in both the CPHD group (HR = 1.329 per 1-unit increase, 95% CI: 1.118–1.580) and the CPHD + CAD group (HR = 1.469 per 1-unit increase, 95% CI: 1.195–1.806),, with the predictive model showing better performance in the latter ( P < 0.001). The predictive value of NLR for right ventricular dysfunction and adverse prognosis exhibits significant disease specificity, being highest in the CPHD + CAD group, moderate in the CPHD group, and of limited practical value in the CAD group. Clinical number: not applicable.