Red Cell Distribution Width And Neutrophil-to-Lymphocyte Ratio Predict Left Ventricular Dysfunction In Acute Anterior ST-segment Elevation Myocardial Infarction

Objective: In this report,we aimed to investigate the relationship between Red cell distribution width(RDW),neutrohil-to-lymphocyte ratio(NLR)and left ventricular systolic function(LVEF)in acute anterior ST-segment elevation myocardial infarction(STEMI)patients who underwent percutaneous coronary intervention(PCI)on admission.Methods: We studied 178 anterior STEMI patients within 12 hours of symptom onset treated with primary PCI from January 2013 to December 2016 in the First Affiliated Hospital of Soochow University.Among them,153 cases of male,female 25 cases,31-90 years old,average age(61.63 ± 12.19)years old.On admission,venous blood was obtained from all the patients,blood routine examination,cardiac troponin and high sensitivity C-reactive protein were measured before starting any medication.And echocardiography was measured on admission.And these patients were underwent coronary angiography and primary percutaneous coronary intervention,in the ending of the operation,observed the blood flow of the cardiovascular.Echocardiogram test of the heart were taken within 24 hours of admission.According to left ventricular ejection fraction(LVEF)on admission,patients were divided to two different groups,as Group I(systolic dysfunction,LVEF < 50%)and Group II(preserved global left ventricle systolic function,LVEF ≥ 50%).The first group included 95 patients and second group included 83 patients.1.Comparing two groups of patients with clinical characteristics,did correlation analysis between LVEF and statistically significant variables.So that we could analysis the relationship between RDW,NLR and the left ventricular ejection fraction.2.The first step was to do the single factor analysis,then do the multivariate Logistic regression among the statistically significant variables in order to filter risk that influence LVEF in anterior STEMI patients treated with primary PCI.3.Drawing ROC curve,analysing the accuracy of RDW and NLR for diagnosis of LVEF in anterior STEMI patients treated with primary PCI.Results: 1.There was no statistically significant difference inage,sex,BMI,hypertension,DM,smoking,blood glucose level,creatinine,or mtroponin.Mean RDW and NLR were significantly higher in Group I compared to Group II(13.66% vs 13.00%,P < 0.01 and 5.39 vs 3.78,P = 0.01),and they both have statistically significant;2.Studying their basic clinical and laboratory indicators,we found that patients,left ventricular ejection fraction was negatively correlated with the level of RDW and NLR(r =-0.68,P < 0.01,vs r =-0.28,P < 0.01)after adjusting age,high blood pressure,fasting glucose,creatinine,troponin,C-reactive protein and other factors.3.White blood cell count,neutrophil count,RDW and NLR were risk factors of left ventricular ejection fraction in anterior STEMI patients treated with primary PCI.Multivariable logistic regression analysis revealed that RDW and NLR were associated with left ventricular ejection fraction in anterior STEMI patients treated with primary PCI.4.The RDW threshold value was 12.95% and the RDW area under the ROC curve was 0.67(95%CI:0.59-0.75)with a sensitivity of 67.40% and a specificity of 55.40% for the diagnosis of left ventricular ejection fraction in anterior STEMI patients treated with primary PCI.The NLR threshold value was 4.01 and the NLR area under the ROC curve was 0.64(95%CI:0.56-0.72)with a sensitivity of 68.40% and a specificity of 59.00%.The RDW united NLR area under the ROC curve was 0.72(95%CI: 0.64-0.79)for the predicts of left ventricular ejection fraction in anterior STEMI patients treated with primary PCI.Conclusions:1.RDW and NLR were significantly higher in left ventricular systolic dysfunction than that of normal left ventricular function in anterior STEMI patients who underwent PCI,and LVEF lower with elevated levels of RDW and NLR,they have a negative correlation relationship.2.RDW and NLR are the early predictors of left ventricular ejection fraction in anterior STEMI patients.3.RDW is better than NLR for anterior STEMI patients to predict the left ventricular ejection fraction,and RDW united NLR used to predict left ventricular ejection function in patients with such disorders have greater predictive value than a single indicators.