Impact of Cardiac Resynchronization Therapy on Indirect Inflammatory Markers

Abstract

Background: Cardiac resynchronization therapy (CRT) is an established treatment for patients with symptomatic chronic heart failure with reduced ejection fraction (HFrEF) and prolonged QRS despite optimal pharmacological therapy. Inflammation plays a crucial role in the pathogenesis and progression of cardiovascular disease. The role of CRT preimplantation inflammatory condition assessed using routine laboratory tests has been rarely investigated. In this study we aimed to evaluate the effect of CRT on indirect inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and lymphocyte-to- the monocyte (LMR) ratio.

Methods: 75 CRT patients were included in the study retrospectively. Before the CRT implantation, clinical and demographic data were recorded from all patients. NLR, PLR and LMR ratio were measured before CRT implantation. The patients were reevaluated minimum six months after CRT; the above-mentioned parameters were measured again and compared to the pre-CRT period.

Results: Compared to the period before CRT, laboratory findings such as white blood cell (3.5 ± 2.2 103 uL vs. 3.2 ± 2.4 103 uL; p =0.006), neutrophyl (1.9 ± 0.4 103 uL; vs. 1.4 ± 0.4 103 uL; p = 0.002), NLR (3.8 ± 0.3 103 uL; vs. 1.7 ± 0.1 103 uL; p <0.001), PLR (490.2± 199 103 uL; vs. 381 ± 105 103 uL; p < 0.001) levels were significantly lower after 6 months of CRT implantation. Lymphocyte counts (0.5 ± 0.3 103 uL vs. 0.8 ± 0.2 103 uL; p = 0.001) were significantly higher in the post CRT group. 

Conclusion: The NLR, PLR and MLR were decreased after CRT implantation. The modest decrease in these parameters demonstrates the effect of restoring the heart’s electromechanical synchrony after CRT on inflammation.