Neutrophil-lymphocyte ratio improves the positive predictive value of dobutamine stress echocardiography.
Background
Neutrophil lymphocyte ratio (NLR) has been shown to predict cardiovascular events in several studies. The aim of this study was to evaluate if NLR improves the positive predictive value of dobutamine stress echocardiography in patients with stable CAD.
Materials and methods
In this retrospective study, the laboratory and DSE medical reports of 1012 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1–3 segments, ischemia in >3 segments). NLR values were compared. NLR values were increased in patients with ischemia and were correlated with the number of ischemic segments (p < 0.001). Optimal cutoff value determined using ROC analysis of NLR > 2.04, the diagnostic value for NLR in discriminating patients with ≥ 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [(AUC =0.671 (SE:0.052), p<0.001 (95% CI: 0.569-0.773)]. As a cutoff value of NLR > 2.04 might be useful in predicting the presence of CAD with significant stenosis with 62.10% sensitivity and 64.10% specificity. The PPV of DSE for a significant coronary artery lesion as identified by coronary angiography was 81.8 % (95% CI: 56.7–75.4). Moreover, when patients with NLR values were >2,04 were analyzed, the PPV of DSE increased to 90.5 % [(85.4–95.6%) p<0.001].(Fig. 1).
Materials and methods
In this retrospective study, the laboratory and DSE medical reports of 1012 patients were reviewed. The patients were divided into two groups based on the presence of ischemia and further subdivided into three groups according to the extent of ischemia (none, ischemia in 1–3 segments, ischemia in >3 segments). NLR values were compared. NLR values were increased in patients with ischemia and were correlated with the number of ischemic segments (p < 0.001). Optimal cutoff value determined using ROC analysis of NLR > 2.04, the diagnostic value for NLR in discriminating patients with ≥ 50% coronary stenosis in at least one of the coronary arteries from those without significant CAD was high [(AUC =0.671 (SE:0.052), p<0.001 (95% CI: 0.569-0.773)]. As a cutoff value of NLR > 2.04 might be useful in predicting the presence of CAD with significant stenosis with 62.10% sensitivity and 64.10% specificity. The PPV of DSE for a significant coronary artery lesion as identified by coronary angiography was 81.8 % (95% CI: 56.7–75.4). Moreover, when patients with NLR values were >2,04 were analyzed, the PPV of DSE increased to 90.5 % [(85.4–95.6%) p<0.001].(Fig. 1).
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