Bhat Geetha, Yost Gardner L, Ibrahim Kamel, Pappas Patroklos, Tatooles Antone
Advocate Christ Medical Center, Center for Heart Transplant and Assist Devices, Heart and Vascular Institute Administration, Oak Lawn, IL, USA.
Int J Artif Organs. 2018 Aug;41(8):445-451. doi: 10.1177/0391398818784276. Epub 2018 Jul 5.
Inflammatory processes are well-characterized risk factors in cardiovascular disease including advanced heart failure. Previous studies have utilized individual white cell subtypes in risk analysis, and a recent study has focused on the efficacy of the neutrophil-to-lymphocyte ratio in evaluating negative outcomes following left ventricular assist device implantation. To investigate the interaction between the left ventricular assist device and white cell counts, we assessed longitudinal changes in neutrophil-to-lymphocyte ratio following left ventricular assist device implantation.
This retrospective study included 100 patients who underwent left ventricular assist device implantation between 2012 and 2013. The neutrophil-to-lymphocyte ratio was calculated prior to left ventricular assist device implantation, daily for the first 30 postoperative days, and at the first two postoperative outpatient visits. Preoperative demographic and clinical data were collected for all patients.
The mean neutrophil-to-lymphocyte ratio immediately before left ventricular assist device implantation was 5.2 ± 4.9. After surgery, the neutrophil-to-lymphocyte ratio decreased asymptotically, from a peak of 29.2 on postoperative day 1 to 4.1 at the second outpatient visit ( p < 0.001). Lack of improvement in the neutrophil-to-lymphocyte ratio at postoperative day 10 was associated with increased length of stay, right heart failure, and a trend toward worsened survival.
Our results indicate a significant inflammatory response to implantation of the left ventricular assist device, a known effect. The magnitude of this response may be effectively and easily monitored over time using the neutrophil-to-lymphocyte ratio. In general, approximately 30 days is required for the neutrophil-to-lymphocyte ratio to return to preoperative levels. After several months, the neutrophil-to-lymphocyte ratio improves to below preoperative levels. It is possible that this reduction reflects the reversal of various heart failure-mediated inflammatory processes following left ventricular assist device implantation.
炎症过程是包括晚期心力衰竭在内的心血管疾病中特征明确的危险因素。以往的研究在风险分析中使用了单个白细胞亚型，最近的一项研究聚焦于中性粒细胞与淋巴细胞比值在评估左心室辅助装置植入后不良结局方面的功效。为了研究左心室辅助装置与白细胞计数之间的相互作用，我们评估了左心室辅助装置植入后中性粒细胞与淋巴细胞比值的纵向变化。
这项回顾性研究纳入了2012年至2013年间接受左心室辅助装置植入的100例患者。在左心室辅助装置植入前、术后第1个30天每日以及术后前两次门诊就诊时计算中性粒细胞与淋巴细胞比值。收集了所有患者的术前人口统计学和临床数据。
左心室辅助装置植入前即刻的平均中性粒细胞与淋巴细胞比值为5.2±4.9。术后，中性粒细胞与淋巴细胞比值呈渐近性下降，从术后第1天的峰值29.2降至第二次门诊就诊时的4.1（p<0.001）。术后第10天时中性粒细胞与淋巴细胞比值未改善与住院时间延长、右心衰竭以及生存恶化趋势相关。
我们的结果表明，左心室辅助装置植入会引发显著的炎症反应，这是一个已知的效应。随着时间的推移，使用中性粒细胞与淋巴细胞比值可以有效且轻松地监测这种反应的程度。一般来说，中性粒细胞与淋巴细胞比值大约需要30天才能恢复到术前水平。几个月后，中性粒细胞与淋巴细胞比值会改善至低于术前水平。这种降低可能反映了左心室辅助装置植入后各种心力衰竭介导的炎症过程的逆转。
