Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?Alpay Arıbaş1, Hakan Akıllı1, Enes Elvin Gül2, Mehmet Kayrak2, Kenan Demir3, Çetin Duman4, Hajrudin Alibasiç2
1Department of Cardiology, Necmettin Erbakan University, Meram Faculty of Medicine, Konya-Turkey
2Department of Cardiology, Faculty of Meram Medicine, Necmettin Erbakan University, Konya-Turkey
3Department of Cardiology, Faculty of Medicine, Selçuk University, Konya-Turkey
4Clinic of Cardiology, Akşehir State Hospital, Konya-Turkey
Objective: High neutrophil/lymphocyte ratio (NLR) has been associated with post-operative AF development in patients who underwent cardiac surgery. In this study, effectiveness of NLR for prediction of recurrence after electrical cardioversion (CV) in non-valvular AF was investigated.
Methods: A total of 149 patients who underwent a successful CV were included in this prospective cohort study. Baseline complete blood cell count, routine biochemical tests, high sensitive C-reactive protein (hs-CRP), and echocardiographic measurements were examined. After CV, patients were monitored over six months for recurrence. Baseline characteristics of recurrence group were compared with sinus rhythm group by using Student`s t -test. Logistic regression analysis was used to determine predictors of recurrence.
Results: Recurrence occurred in a total of 46 patients (30.9%). Median AF duration [16 (IQR: 14.25) vs. 12 (IQR: 11) months, p=0.01], baseline hs-CRP [9.80 (IQR: 8.50) mg/dL vs. 4.28 (IQR: 5.65) mg/dL, p=0.002] and left atrium (LA) diameter (4.5±0.4 cm, 4.3±0.5 cm, p=0.023) were significantly higher in the recurrence group than sinus rhythm group. Median NLR was comparable in recurrence and sinus groups [2.38 (IQR: 2.09) vs. 2.23, (IQR: 1.23) p=0.96, respectively]. There was a weak correlation between NLR and hs-CRP (r=0.22, p=0.05) and age (r=0.24, p=0.02). In multiple logistic regression analysis, hs-CRP [OR: 1.34 (1.09-1.65 95% CI) p=0.006], LA diameter [OR: 11.92 (1.84-77.07 95% CI) p=0.01], spontaneous echo contrast positivity, [OR: 5.40 (1.04-12.02 95% CI) p=0.045] and systolic blood pressure [OR: 1.05 (1.01-1.10 95% CI) p=0.03] were independent predictors of AF recurrence.
Conclusion: NLR failed to predict AF recurrence after a successful electrical CV, but hs-CRP remained an inflammatory marker of AF recurrenceKeywords: Atrial fibrillation, electric countershock, inflammation, recurrence, neutrophils- lymphocytes, logistic regression analysis
Alpay Arıbaş, Hakan Akıllı, Enes Elvin Gül, Mehmet Kayrak, Kenan Demir, Çetin Duman, Hajrudin Alibasiç. Can neutrophil/lymphocyte ratio predict recurrence of non-valvular atrial fibrillation after cardioversion?. Anatol J Cardiol. 2013; 13(2): 123-130