title: Relationship between neutrophil-to-lymphocyte ratio and impaired myocardial perfusion in cardiac syndrome X.
abstract: OBJECTIVE
  Myocardial tissue perfusion is decreased in patients with cardiac syndrome X (CSX). Systemic inflammation appears to be an important contributor to the diseased microvascular network of these patients. The neutrophil-to-lymphocyte ratio (NLR) is a surrogate marker of inflammation. Accordingly, we evaluated this biomarker concerning the microvascular circulation of CSX patients.
  
  
  METHODS
  This study included 60 consecutive patients (54.1 ± 7.8 years of age, 49 females) with CSX (typical chest pain, positive exercise stress test results, and normal coronary angiograms) and 60 consecutive age- and sex-matched control subjects. In all coronary territories, epicardial coronary flow was assessed by the Thrombolysis In Myocardial Infarction frame count (TFC) method, and myocardial tissue perfusion was assessed by the myocardial blush grade (MBG) method. Normal myocardial perfusion was accepted as an MBG score of 3 in all coronary territories.
  
  
  RESULTS
  Patients with CSX had higher NLRs than those of control subjects (1.98 ± 0.77 vs 1.72 ± 0.55, respectively; p = 0.04). Among patients with CSX, those with impaired myocardial perfusion had higher NLRs than those with normal myocardial perfusion (2.13 ± 0.82 vs 1.71 ± 0.59, respectively; p = 0.028). There was a negative correlation between the NLR and total MBG score (p = 0.027, r = -0.29). Logistic regression analysis showed that the NLR was an independent and negative predictor of myocardial tissue perfusion (p = 0.027; Beta, -1.057; odds ratio, 2.878; 95% confidence interval, 1.129-7.335).
  
  
  CONCLUSIONS
  Patients with CSX have high NLRs, and inflammation seems to be associated with distorted myocardial perfusion in these patients.
authors.affiliation: Department of Cardiology, Baskent University Medical School, Ankara Education and Research Hospital, Fevzi Cakmak Caddesi, Bahcelievler, Ankara, Turkey. drokyay@yahoo.com.
authors.forename: K
authors.initials: K
authors.lastname: Okyay
authors.forename: M
authors.initials: M
authors.lastname: Yilmaz
authors.forename: A
authors.initials: A
authors.lastname: Yildirir
authors.forename: S
authors.initials: S
authors.lastname: Eroglu
authors.forename: E
authors.initials: E
authors.lastname: Sade
authors.forename: A
authors.initials: A
authors.lastname: Sahinarslan
authors.forename: A
authors.initials: A
authors.lastname: Aydinalp
authors.forename: H
authors.initials: H
authors.lastname: Muderrisoglu
mesh_terms: D000368:Aged; D003326:Coronary Circulation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008214:Lymphocytes / Q000378:metabolism*; D008297:Male; D017566:Microvascular Angina / Q000097:blood* / Q000000981:diagnostic imaging*; D055806:Microvessels / Q000000981:diagnostic imaging*; D008875:Middle Aged; D009504:Neutrophils / Q000378:metabolism*; D011859:Radiography; D012189:Retrospective Studies