title: Heart rate recovery after exercise and its relation with neutrophil-to-lymphocyte ratio in patients with cardiac syndrome X.
abstract: OBJECTIVE
  The neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) are measures of systemic inflammation. Heart rate recovery (HRR) after exercise is influenced by autonomic function. The aim of this study was to ascertain whether HRR and the Duke Treadmill Score (DTS) values are related to NLR and PLR in patients with cardiac syndrome X (CSX).
  
  
  METHODS
  A total of 350 participants were enrolled in the study. Complete blood counts and high-sensitivity C-reactive protein (hsCRP) were obtained. All participants underwent an exercise test. HRR and DTS were calculated after exercise. Abnormal HRR was defined as 12 beats/min or less.
  
  
  RESULTS
  CSX and coronary artery disease (CAD) groups had higher NLR, PLR, and hsCRP, and lower HRR and DTS values than the control group (for all, P<0.05). In both CSX and CAD groups, HRR was positively correlated with DTS (r=0.468, P<0.001 and r=0.491, P<0.001, respectively) and negatively correlated with NLR (r=-0.519, P<0.001 and r=-0.612, P<0.001, respectively), PLR (r=-0.422, P<0.001 and r=-0.438, P<0.001, respectively), and hsCRP (r=-0.553, P<0.001 and r=-0.521, P<0.001, respectively). NLR and hsCRP were important two predictors of the presence of lower HRR in both CSX [NLR: odds ratio (OR), 0.395; 95% confidence interval (CI), 0.168-0.925; P=0.032 and hsCRP: OR, 0.748; 95% CI, 0.591-0.945; P=0.015], and CAD groups (NLR: OR, 0.115; 95% CI, 0.026-0.501; P=0.004 and hsCRP: OR, 0.637; 95% CI, 0.455-0.892; P=0.009).
  
  
  CONCLUSIONS
  CSX patients have higher NLR and PLR and slower HRR and lower DTS, similar to CAD patients, suggesting that CSX patients may be at a higher risk for developing cardiovascular events in the future. NLR may predict autonomic imbalance assessed by HRR in CSX.
authors.affiliation: aDepartment of Cardiology, Van Region Training and Research Hospital bDepartment of Cardiology, Istanbul Hospital, Van cDepartment of Cardiology, School of Medicine, Pamukkale University, Denizli, Turkey.
authors.forename: Mustafa
authors.initials: M
authors.lastname: Yurtdaş
authors.forename: Yalin T
authors.initials: YT
authors.lastname: Yaylali
authors.forename: Nesim
authors.initials: N
authors.lastname: Aladağ
authors.forename: Mahmut
authors.initials: M
authors.lastname: Özdemir
authors.forename: Yemlihan
authors.initials: Y
authors.lastname: Ceylan
authors.forename: Murat
authors.initials: M
authors.lastname: Gençaslan
authors.forename: Tayyar
authors.initials: T
authors.lastname: Akbulut
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology*; D015444:Exercise; D005080:Exercise Test; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D018655:Lymphocyte Count; D008214:Lymphocytes; D017566:Microvascular Angina / Q000097:blood* / Q000175:diagnosis / Q000503:physiopathology*; D008875:Middle Aged; D009504:Neutrophils; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020127:Recovery of Function; D012307:Risk Factors; D013997:Time Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein