Du Xinjia, Liu Jiahua, Zhang Zeqing, Ren Yanfei, Chen Lei, Lu Yuan, Zhang Zhuoqi
Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
Front Cardiovasc Med. 2025 Apr 24;12:1465350. doi: 10.3389/fcvm.2025.1465350. eCollection 2025.
Current evidence suggested a correlation between inflammation and Left Ventricular Thrombus (LVT). The lymphocyte to C-reactive protein ratio (LCR) has been established as be a reliable inflammation marker and is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). However, its relationship with the occurrence of LVT remains unclear. This study aims to evaluate the effectiveness of LCR in predicting LVT in patients with STEMI after undergoing primary percutaneous coronary intervention (pPCI).
A total of 564 STEMI patients who underwent pPCI at the Affiliated Hospital of Xuzhou Medical University from September 2019 to June 2024 were included. Cardiac magnetic resonance imaging (CMR) was used to assess myocardial infarction characteristics and the presence of LVT. The definition of LCR is the lymphocyte to C-reactive protein ratio.
Out of 564 patients, 57 were diagnosed with LVT. The median time for CMR testing was 5 (4, 6) days. Univariate regression analysis showed significant differences in left ventricular ejection fraction (LVEF), peak N-terminal pro B-type natriuretic peptide (peak NT-proBNP), peak high-sensitivity troponin T (peak hsTnT), LCR, Late Gadolinium Enhancement% (LGE%), and Microvascular Obstruction% (MVO%) ( < 0.05). Multivariate regression analysis indicated that LCR was an independent predictor for LVT ( = 0.007, OR: 0.001 95% CI: 0.00-0.123). Receiver operating characteristic (ROC) curve analysis showed that LCR has good predictive ability for LVT (Area under the curve: 0.704, < 0.001). Integration of integral LCR could significantly improve the discrimination and reclassification accuracy for LVT after STEMI (NRI = 0.517, IDI = 0.030; < 0.001).
Lower LCR is independently associated with the risk of LVT in patients with STEMI after pPCI. Integration of LCR can significantly improve the risk model for LVT.
目前的证据表明炎症与左心室血栓（LVT）之间存在关联。淋巴细胞与C反应蛋白比值（LCR）已被确立为一种可靠的炎症标志物，且与ST段抬高型心肌梗死（STEMI）患者的预后相关。然而，其与LVT发生的关系仍不明确。本研究旨在评估LCR在预测接受直接经皮冠状动脉介入治疗（pPCI）的STEMI患者发生LVT方面的有效性。
纳入2019年9月至2024年6月在徐州医科大学附属医院接受pPCI的564例STEMI患者。采用心脏磁共振成像（CMR）评估心肌梗死特征及LVT的存在情况。LCR的定义为淋巴细胞与C反应蛋白的比值。
564例患者中，57例被诊断为LVT。CMR检测的中位时间为5（4，6）天。单因素回归分析显示，左心室射血分数（LVEF）、N末端B型利钠肽原峰值（peak NT-proBNP）、高敏肌钙蛋白T峰值（peak hsTnT）、LCR、钆延迟强化百分比（LGE%）和微血管阻塞百分比（MVO%）存在显著差异（P<0.05）。多因素回归分析表明，LCR是LVT的独立预测因子（P=0.007，OR：0.001，95%CI：0.00-0.123）。受试者工作特征（ROC）曲线分析显示，LCR对LVT具有良好的预测能力（曲线下面积：0.704，P<0.001）。整合完整的LCR可显著提高STEMI后LVT的鉴别和重新分类准确性（NRI=0.517，IDI=0.030；P<0.001）。
较低的LCR与pPCI术后STEMI患者发生LVT的风险独立相关。整合LCR可显著改善LVT的风险模型。
