Inflammatory Markers as Predictors of Atrial Fibrillation Recurrence: Exploring the C-Reactive Protein to Albumin Ratio in Cryoablation Patients.

BACKGROUND: Atrial fibrillation (AF) is a common cardiac rhythm disorder associated with hemodynamic disruptions and thromboembolic events. While antiarrhythmic drugs are often recommended as the initial treatment, catheter ablation has emerged as a viable alternative. However, the recurrence of AF following ablation remains a challenge, and there is growing interest in exploring inflammatory markers as predictors of recurrence. METHODS: This retrospective, cross-sectional analysis included 249 patients who underwent cryoablation for paroxysmal AF. The relationship between the 'C-reactive protein (CRP) to albumin ratio (CAR)' and AF recurrence was examined. RESULTS: Two hundred and forty-nine patients with paroxysmal non-valvular atrial fibrillation were included. They were divided into two groups: those without recurrence (Group 1) and those with recurrence (Group 2). Significant differences were observed in age (57.2 ± 9.9 vs. 62.5 ± 8.4, p = 0.001) and left atrial size (4.0 ± 0.5 vs. 4.2 ± 0.7, p = 0.001) between the two groups. In blood parameters, significant differences were found in CRP (5.2 ± 1.3 vs. 9.4 ± 2.8, p < 0.001) and neutrophil counts (5.1 ± 2.2 vs. 6.7 ± 3.6, p = 0.001). In univariate regression analysis, age (OR: 1.058, CI: 1.024-1.093, p = 0.001), WBC count (OR: 1.201, CI: 1.092-1.322, p < 0.001), neutrophil count (OR: 1.239, CI: 1.114-1.378, p = 0.001), CAR (OR: 1.409, CI: 1.183-1.678, p < 0.001), and left atrial diameter (OR: 0.968, CI: 0.948-0.989, p = 0.002) showed significant associations with AF recurrence. CONCLUSIONS: Inflammation plays a crucial role in the initiation and progression of AF. This study demonstrated that along with age, the CAR can serve as an independent predictor of AF recurrence following cryoablation.

Increasing modified CHA2DS2-VASc risk score is associated with acute cardiac injury in hospitalised COVID-19 patients.

BACKGROUND: Prediction of hospital mortality in patients with COVID-19 by the CHA2DS2VASc (M-CHA2DS2VASc) has been recently shown. Because COVID-19 patients with acute cardiac injury have higher mortality compared to those without, we assumed that this risk score may also predict acute cardiac injury in these patients. METHODS: In this retrospective, single centre cohort study, we included 352 hospitalised patients with laboratory-confirmed COVID-19 and divided into three groups according to M-CHA2DS2VASc risk score which was created by changing gender criteria of the CHA2DS2VASc from female to male (Group 1, score 0-1 (n = 142); group 2, score 2-3 (n = 138) and group 3, score ≥4 (n = 72)). RESULTS: As the M-CHA2DS2VASc risk score increased, acute cardiac injury was also significantly increased (Group 1, 11.3%; group 2, 48.6%; group 3, 76%; p < 0.001). The higher M-CHA2DS2VASc tertile had higher prevalence of arrhythmias compared to lower tertile. The multivariate logistic regression analysis showed that M-CHA2DS2VASc risk score, admission to intensive care unit and invasive mechanical ventilation were independent predictors of acute cardiac injury (p = 0.001, odds ratio 1.675 per scale for M-CHA2DS2VASc). In receiver operating characteristic analysis, M-CHA2DS2VASc risk score was able to predict acute cardiac injury (Area under the curve value for acute cardiac injury was 0.80; p < 0.001). CONCLUSION: Admission M-CHA2DS2VASc risk score was associated with acute cardiac injury in hospitalised patients with COVID-19.

Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with cryptogenic stroke in patients with patent foramen ovale.

INTRODUCTION: Although most ischaemic strokes are due to cardioembolism, about 25-40% of strokes are cryptogenic. Patent foramen ovale has been associated with cryptogenic stroke; however, the precise mechanism of this association has not been demonstrated. The aim of this study was to evaluate the association between inflammatory markers and cryptogenic stroke in patients with patent foramen ovale. MATERIAL AND METHODS: We included 206 patients with patent foramen ovale. Ninety-four (45.63%) out of 206 patients had had stroke, and 112 (54.37%) had not had stroke. The ratio of the total neutrophil count to the total lymphocyte count was defined as the neutrophil to lymphocyte ratio, and the ratio of the absolute platelet count to the absolute lymphocyte count was determined as the platelet to lymphocyte count. RESULTS: The neutrophil to lymphocyte ratio was significantly higher in patients who had stroke than in those who did not (2.41 ±1.69 vs. 2.19 ±1.74, p = 0.047). Although the platelet to lymphocyte count was also higher in patients who had had stroke than in those who had not, it was not statistically significant (120.94 ±55.45 vs. 118.01 ±52.21, p = 0.729). 1.62 was the cut-off value for neutrophil to lymphocyte ratio to be associated with stroke with 73.4% sensitivity and 45.05% specificity (p = 0.042). CONCLUSIONS: This study demonstrated that elevated neutrophil to lymphocyte ratio and platelet to lymphocyte count could be associated with cryptogenic stroke in patients with patent foramen ovale.