Author + information
- Mustafa Ozan Gürsoy,
- Macit Kalçık,
- Süleyman Karakoyun,
- Mahmut Yesin,
- Sabahattin Gündüz,
- Mehmet Ali Astarcıoğlu and
- Mehmet Özkan
There is an established relation between neutrophil/lymphocyte ratio (NLR) and adverse outcomes in patients with cardiovascular diseases. Recently, small studies have shown that NLR is independently associated with spontaneous echo contrast in patients with mitral stenosis. In this study, we aimed to investigate the role of NLR in patients with functional and thrombotic prosthetic mitral valve.
214 subjects with prosthetic valves were analyzed retrospectively in this comparative monocentric study. The patients with prosthetic valve thrombosis (PVT) were further classified as obstructive versus nonobstructive (group 1 and group 2). The control group (group 3) included the patients with functional mitral prosthesis. Two dimensional and real-time 3 dimensional transesophageal echocardiography were performed to confirm or to exclude the presence of thrombus. Doppler study was performed for assessment of valvular obstruction. NLR was calculated using data obtained from the complete blood count and taken at the time of admission before the administration of any fibrinolytic therapy. The exclusion criteria included treatment with fibrinolytics in the previous 24 h, active infection, past history of a systemic inflammatory process, malignancy, end-stage liver disease and renal failure.
The groups were composed of 100, 51 and 63 patients, respectively. Mean age was 49± 13 years. There was no significant difference between age and sex among the 3 groups. The mean transvalvular gradients were 12.4±2.4 mmHg, 4.1±1.1mmHg, 3.9±0.9mmHg, respectively (p<0.001). The mean thrombus area was 0.9±0.3 cm2, (range;0.4-1.8 cm2) in group 1 and 1.7±1.1cm2, (range between 0.8-6 cm2) in group 2 (p=0.032). With respect to NLR, it differed significantly across tertiles (3.9± 1.9, 2.7±1.4, 2.8±1.4, p<0.001) and group 1 had significantly higher NLR compared to group 2 and 3. There was a very strong correlation between the mean transvalvular gradient and NLR (r=0.865; p<0.001). Furthermore there was a strong correlation between the mean thrombus area and NLR (r=0.685; p<0.001). In this study, a NLR level of >2.7, measured upon admission, had 72% sensitivity and 60% specificity in predicting the development of obstructive PVT.
In this large-scaled study we showed that NLR, a novel biomarker, was associated with severity of obstruction in patients with PVT and it could inform the clinician about the total thrombus burden.