The Association between Neutrophil to Lymphocyte Ratio and Systolic Right Ventricular Dysfunction in Patients with Acute Inferior ST- Segment Elevation Myocardial Infarction

Abstract
Background: Ischemic heart disease is considered the most common cause of death worldwide. Inflammation and oxidative stress play an important role in the pathogenesis of all phases of atherosclerosis and atherosclerotic plaque rupture which are the main mechanisms in the pathophysiology of acute ST-segment Elevation Myocardial Infarction (STEMI). Acute inferior STEMI is associated with increased in-hospital morbidity and mortality particularly among patients with coexisting Right Ventricular (RV) involvement. High Neu-trophil to Lymphocyte Ratio (NLR) is an independent predictor of major adverse cardiac events and mortality in patients with myocardial infarction.
Aim of Study: To study the relationship between the NLR and RV Dysfunction (RVD) in patients with inferior STEMI who underwent primary Percutaneous Coronary Intervention (PCI) or received fibrinolytic therapy. RVD measured by Tricuspid Annular Plane Systolic Excursion (TAPSE) Patients and Methods: This study was conducted on sixty patients diagnosed with acute inferior STEMI and underwent primary PCI or received fibrinolytic therapy in Tanta University Hospitals, Cardiovascular Department, from December 2017 to June 2018. The cases were divided into two groups according to the presence of RVD or not. The groups were compared according to NLR and Receiver Operating Characteristic (ROC) analysis was performed to access the predictability of high NLR in patients with RVD.
Results: The NLR was significantly higher in the group with RVD compared to that without RVD (p=0.002). In ROC analysis, NLR >3.2 predicted RVD with sensitivity of 82.16% and specificity of 89.19%. In a multivariate regression analysis, NLR remained an independent predictor of RVD (95% C.I 0.787-0.976, p=0.002).
Conclusion: NLR was an independent predictor of RVD in patients with acute inferior STEMI who underwent primary PCI or received fibrinolytic therapy.