Background and Objectives In this study, we examined the role of

Background and Objectives In this study, we examined the role of inflammatory parameters in an apical mural thrombus with a reduced ejection fraction due to large anterior myocardial infarction (MI). Similarly there were no statistically significant differences in terms of biochemical and echocardiographic parameters (p>0.05). However, there were significant differences in terms of neutrophil lymphocyte ratio (p=0.032). After a multivariate regression analysis, neutrophil lymphocyte ratio (NLR) was an independent predictor of thrombus formation (: 0.296, p=0.024). The NLR >2.74 had a 78% sensivity and 61% specifity in predicting thrombus in patients with a low left ventricular ejection fraction. Conclusion In this study, neutrophil lymphocyte ratios were significantly higher in patients with apical thrombus. Keywords: Inflammation, Thrombus, Myocardial infarction Introduction Left ventricular apical thrombus (AT) is one of the major complications after a myocardial infarction (MI).1) The incidence of AT is reported to be 30-40% as in postmortem.1) In most of the cases, left ventricular AT accompanies wall motion disorders such as ischemic and nonischemic heart diseases.1) Hypercoagulable or inflammatory states might rarely predispose to thrombus formation.2) It usually occurs with a large anterior MI, particularly in the presence of a left ventricular aneurysm and apical akinesia.1) The AMI represents a good model for studying thrombus formation since all pre-requisites for thrombus formation are present in this particular setting (i.e. endothelial injury, hypercoagulable state, and blood stasis). Reduced left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI) is known to be correlated strongly with AT and most often occurs as a result of anterior and apical AMI.3),4),5),6) Neutrophil lymphocyte ratio (NLR) has been suggested as an important and cheap prognostic factor in patients with coronary heart disease (CHD).7),8) In addition, neutrophilia and relative lymphocytopenia were shown to be independent predictors of mortality in patients with heart failure9),10) as neutrophils play an important role in tissue destruction. In recent years, several studies have show the crucial role of neutrophils in thrombosis.9),10),11) Therefore, neutrophils might enhance or trigger thrombotic events via production and expression of tissue factor (TF).12) Hence, the aim of this study was to determine the role of neutrophil to lymphocyte ratios (NLR) in an apical mural thrombus among Cevipabulin (TTI-237) post large anterior MI patients with reduced ejection fraction. Subjects and Methods In this study, 45 patients aged 58 with a left ventricular AT after a large Rabbit Polyclonal to Collagen I alpha2 (Cleaved-Gly1102) anterior MI and ejection fraction, and sex-matched patients without a left ventricular AT after a large anterior MI were used as a control group and enrolled retrospectively. The exclusion criteria were the presence of infection, nonischemic cardiomyopathy, current therapy with corticosteroid, non steroidal Cevipabulin (TTI-237) anti-inflamatory drugs, warfarin and heparin derivatives, hematological disorders, and connective tissue diseases. Blood samples were drawn from a large antecubital vein for determination of biochemical and Cevipabulin (TTI-237) hemostatic parameters (Symex K-1000, Kobe, Japan) on admission. All routine biochemical tests were performed using an auto-analyzer (Roche Diagnostic Modular Systems, Tokyo, Japan). The NLR was defined as the absolute neutrophil count in peripheral blood divided by total lymphocyte count, and the platelet to lymphocyte ratio (PLR) was defined as the absolute platelet count in the peripheral blood divided by the total lymphocyte count The echocardiographic features of patients which had been performed were evaluated after 6 weeks of MI. A two-dimensional echocardiography was performed with a 3.5 MHz transducer (IE33, Philips Medical Systems, Andover, MA, USA). The left atrial diameter was assessed in a parasternal short axis view. Simpson’s method was used to asses the left ventricular ejection fraction in a two-dimensional echocardiographic apical four chamber view, as recommended by the American society of echocardiography guidelines.13) All images had been archived and were evaluated by independent cardiologists who were blinded to each patient’s data. Statistical analysis After assessing data compatibility with normal distribution using the Kolmogorov-Smirnov test, a Student’s t-test was used to compare normally distributed data between Cevipabulin (TTI-237) groups, and the Mann-Whitney U test was used for nonnormally distributed data. The chi-square test was used in the investigation of categoric variables. A multiple linear regression analysis was performed for parameters affecting the presence of thrombus. Normally distributed data are expressed as meanstandard deviations and non-normally distributed data are expressed as Cevipabulin (TTI-237) a percentage. Receiver operating characteristic (ROC) curve analysis was performed to detect the cut-off value of the NLR ratio in predicting thrombus. All statistical analyses were performed with SPSS ver. 16.0 (SPSS Inc.,.