Atherosclerosis · 2025
Association of monocyte-to-lymphocyte ratio with coronary endothelial dysfunction and cardiovascular events in patients with angina and nonobstructive coronary artery disease.
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Kalhor Parvin, Mahmoudi Hamidabad Negin, Hellou Elias, Nogami Kai, Manzato Matteo, Lerman Lilach O, Lerman Amir
Аннотация
BACKGROUND: Coronary endothelial dysfunction (CED) is regarded as an early stage of atherosclerosis. Inflammation plays a key role in the mechanism and progression of atherosclerosis, but its clinical utility in the initial phase is less clear.
METHODS: Patients with angina and nonobstructive coronary artery disease who underwent coronary reactivity testing at the Mayo Clinic between 1997 and 2021 were enrolled. Endothelium-dependent microvascular dysfunction was a <50 % change in coronary blood flow, and endothelium-dependent epicardial dysfunction was a < -20 % change in epicardial arterial diameter, both with acetylcholine. Endothelium-independent microvascular dysfunction was a coronary flow reserve <2.5 with adenosine, and endothelium-independent epicardial dysfunction was a <20 % change in cross-sectional area after nitroglycerin. Preprocedural monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and hs-CRP were used for major adverse cardiovascular and cerebrovascular events (MACCE) prediction.
RESULTS: In 892 enrolled patients, with a median age of 52[43-61] years, 31 % were male. MLR was significantly higher in patients with endothelium-dependent epicardial (0.281 vs. 0.268, p = 0.042) and microvascular dysfunction (0.280 vs. 0.265, p = 0.015). However, no significant MLR differences were observed in patients with endothelium-independent epicardial or microvascular dysfunction. In a 10-year follow-up, in univariate Cox Regression, higher MLR, NLR and hs-CRP levels were associated with higher MACCE. However, in multivariate Cox Regression for traditional risk factors, only MLR remained a significant independent predictor of MACCE (HR = 1.88, 95 %CI = 1.30-2.71, p < 0.001).
CONCLUSIONS: CED is associated with higher levels of MLR. Elevated MLR is independently linked to higher MACCE and may offer potential for early-stage atherosclerosis risk assessment.
METHODS: Patients with angina and nonobstructive coronary artery disease who underwent coronary reactivity testing at the Mayo Clinic between 1997 and 2021 were enrolled. Endothelium-dependent microvascular dysfunction was a <50 % change in coronary blood flow, and endothelium-dependent epicardial dysfunction was a < -20 % change in epicardial arterial diameter, both with acetylcholine. Endothelium-independent microvascular dysfunction was a coronary flow reserve <2.5 with adenosine, and endothelium-independent epicardial dysfunction was a <20 % change in cross-sectional area after nitroglycerin. Preprocedural monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and hs-CRP were used for major adverse cardiovascular and cerebrovascular events (MACCE) prediction.
RESULTS: In 892 enrolled patients, with a median age of 52[43-61] years, 31 % were male. MLR was significantly higher in patients with endothelium-dependent epicardial (0.281 vs. 0.268, p = 0.042) and microvascular dysfunction (0.280 vs. 0.265, p = 0.015). However, no significant MLR differences were observed in patients with endothelium-independent epicardial or microvascular dysfunction. In a 10-year follow-up, in univariate Cox Regression, higher MLR, NLR and hs-CRP levels were associated with higher MACCE. However, in multivariate Cox Regression for traditional risk factors, only MLR remained a significant independent predictor of MACCE (HR = 1.88, 95 %CI = 1.30-2.71, p < 0.001).
CONCLUSIONS: CED is associated with higher levels of MLR. Elevated MLR is independently linked to higher MACCE and may offer potential for early-stage atherosclerosis risk assessment.