Clinical significance of platelet to lymphocyte ratio in evaluating the recurrence of radiofrequency ablation in patients with atrial fibrillation

doi:10.11817/j.issn.1673-9248.2022.03.008

Abstract

Abstract:

Objective

To investigate the clinical significance of platelet to lymphocyte ratio (PLR) in evaluating the recurrence of patients with atrial fibrillation (AF) after radiofrequency catheter ablation (RFCA).

Methods

Totally 312 patients with AF who received RFCA in Henan Provincial People’s Hospital from January 2013 to January 2018 were included. Patients were divided into recurrence group (n=85) and non-recurrence group (n=227) according to whether AF reoccurred 3 months after ablation. The general clinical data, laboratory indexes and echocardiography indexes of the two groups were analyzed. Logistic regression was used to analyze the related factors of AF recurrence after RFCA, and receiver operating characteristic (ROC) curve was used to evaluate the value of PLR in predicting the recurrence of AF after RFCA. The patients were divided into high PLR group (n=156) and low PLR group (n=156) according to the median PLR, and Kaplan-Meier survival curve was used to analyze the prognosis.

Results

Univariate analysis showed that age, course of atrial fibrillation, type of atrial fibrillation, high-sensitivity C-reactive protein (hs-CRP), neutrophils, platelets (PLT), lymphocytes, PLR, and left atrial diameter (LAD) had a positive effect on the AF recurrence after RFCA (P＜0.05). Multiple Logistic regression showed that age (OR=1.047), persistent atrial fibrillation (OR=2.519), hs-CRP (OR=2.249), PLT (OR=1.023), PLR (OR=1.030) and LAD (OR=1.224) were the independent risk factors for recurrence of AF recurrence after RFCA (P＜0.05), lymphocyte (OR=0.255) was protective factor for recurrence of AF recurrence after RFCA (P＜0.05). ROC curve showed that area under curve (AUC) predicted by PLR for AF recurrence after RFCA was 0.725（95%CI：0.672-0.774，P＜0.001）. The results of Kaplan-Meier survival curve showed that the recurrence of AF in high PLR group was significantly higher than that in low PLR group (P＜0.001).

Conclusion

The level of PLR is closely related to the recurrence of AF after RFCA. The high level of PLR can be used as a signal to predict the recurrence of AF. Clinical monitoring of PLR should be strengthened to evaluate the prognosis of patients in a timely manner.

Key words: Platelet/lymphocyte ratio, Inflammatory reaction, Atrial fibrillation, Radiofrequency catheter ablation, Recrudesce

Zhiwen Zhang, Zhibo Lei, Muwei Li, Gairong Huang, Shanling Wang, Jingjing Liu, Ting Wang, Danqing Zhao, Haitao Yang. Clinical significance of platelet to lymphocyte ratio in evaluating the recurrence of radiofrequency ablation in patients with atrial fibrillation[J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2022, 16(03): 188-192.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhnxgbzz.cma-cmc.com.cn/EN/10.11817/j.issn.1673-9248.2022.03.008

https://zhnxgbzz.cma-cmc.com.cn/EN/Y2022/V16/I03/188

Figures/Tables 4

指标	复发组（n=85）	未复发组（n=227）	统计值	P值
性别男/女，[例]	52/33	148/79	χ²=0.435	0.510
年龄（岁， $x ¯$ ±s）	57.4±10.7	52.6±10.5	t=2.582	0.001
抽烟[例（%）]	12（14.1）	45（19.8）	χ²=1.349	0.246
饮酒[例（%）]	13（15.3）	40（17.6）	χ²=0.237	0.625
高血压[例（%）]	37（43.5）	84（37.0）	χ²=1.109	0.292
冠心病[例（%）]	11（12.9）	22（9.7）	χ²=0.690	0.406
糖尿病[例（%）]	18（21.2）	34（15.0）	χ²=1.711	0.191
血脂异常[例（%）]	30（35.3）	61（26.9）	χ²=2.123	0.145
体质量指数（kg/m², $x ¯$ ±s）	24.2±3.1	25.1±3.8	t=1.190	0.236
房颤病程[年，例（%）]			χ²=10.569	0.001
≥1	32（37.6）	45（19.8）
＜1	53（62.4）	182（80.2）
房颤类型[例（%）]			χ²=15.890	＜0.001
阵发性房颤	35（41.2）	150（66.1）
持续性房颤	50（58.8）	77（33.9）
hs-CRP（mg/L， $x ¯$ ±s）	3.8±0.8	3.2±0.9	t=5.412	＜0.001
中性粒细胞（×10⁹/L, $x ¯$ ±s）	5.1±0.9	4.9±0.8	t=2.063	0.040
PLT（×10⁹/L, $x ¯$ ±s）	257.1±30.6	234.3±32.2	t=5.647	＜0.001
淋巴细胞（×10⁹/L, $x ¯$ ±s）	1.9±0.5	2.1±0.4	t=-3.734	＜0.001
PLR（ $x ¯$ ±s）	135.8±25.2	114.6±26.1	t=6.463	＜0.001
LAD（mm, $x ¯$ ±s）	42.3±4.1	39.8±3.4	t=5.169	＜0.001
LVEDD（mm, $x ¯$ ±s）	44.8±5.3	46.1±6.1	t=-1.849	0.066
LVEF（%, $x ¯$ ±s）	57.5±8.7	59.2±8.6	t=-1.550	0.122
治疗药物[例（%）]
ACEI/ARB	23（27.1）	74（32.6）	χ²=0.886	0.347
CCB	17（20.0）	50（22.0）	χ²=0.151	0.698
β受体阻滞剂[例（%）]	46（54.1）	147（64.8）	χ²=2.967	0.085
胺碘酮[例（%）]	22（25.9）	77（33.9）	χ²=1.845	0.174

指标	复发组（n=85）	未复发组（n=227）	统计值	P值
性别男/女，[例]	52/33	148/79	χ²=0.435	0.510
年龄（岁， $x ¯$ ±s）	57.4±10.7	52.6±10.5	t=2.582	0.001
抽烟[例（%）]	12（14.1）	45（19.8）	χ²=1.349	0.246
饮酒[例（%）]	13（15.3）	40（17.6）	χ²=0.237	0.625
高血压[例（%）]	37（43.5）	84（37.0）	χ²=1.109	0.292
冠心病[例（%）]	11（12.9）	22（9.7）	χ²=0.690	0.406
糖尿病[例（%）]	18（21.2）	34（15.0）	χ²=1.711	0.191
血脂异常[例（%）]	30（35.3）	61（26.9）	χ²=2.123	0.145
体质量指数（kg/m², $x ¯$ ±s）	24.2±3.1	25.1±3.8	t=1.190	0.236
房颤病程[年，例（%）]			χ²=10.569	0.001
≥1	32（37.6）	45（19.8）
＜1	53（62.4）	182（80.2）
房颤类型[例（%）]			χ²=15.890	＜0.001
阵发性房颤	35（41.2）	150（66.1）
持续性房颤	50（58.8）	77（33.9）
hs-CRP（mg/L， $x ¯$ ±s）	3.8±0.8	3.2±0.9	t=5.412	＜0.001
中性粒细胞（×10⁹/L, $x ¯$ ±s）	5.1±0.9	4.9±0.8	t=2.063	0.040
PLT（×10⁹/L, $x ¯$ ±s）	257.1±30.6	234.3±32.2	t=5.647	＜0.001
淋巴细胞（×10⁹/L, $x ¯$ ±s）	1.9±0.5	2.1±0.4	t=-3.734	＜0.001
PLR（ $x ¯$ ±s）	135.8±25.2	114.6±26.1	t=6.463	＜0.001
LAD（mm, $x ¯$ ±s）	42.3±4.1	39.8±3.4	t=5.169	＜0.001
LVEDD（mm, $x ¯$ ±s）	44.8±5.3	46.1±6.1	t=-1.849	0.066
LVEF（%, $x ¯$ ±s）	57.5±8.7	59.2±8.6	t=-1.550	0.122
治疗药物[例（%）]
ACEI/ARB	23（27.1）	74（32.6）	χ²=0.886	0.347
CCB	17（20.0）	50（22.0）	χ²=0.151	0.698
β受体阻滞剂[例（%）]	46（54.1）	147（64.8）	χ²=2.967	0.085
胺碘酮[例（%）]	22（25.9）	77（33.9）	χ²=1.845	0.174

变量	β值	SE值	Wald χ²值	OR值	95%CI	P值
年龄	0.046	0.017	6.925	1.047	1.012~1.083	0.008
房颤病程	0.535	0.366	2.143	1.708	0.834~3.496	0.143
持续性房颤	0.924	0.341	7.331	2.519	1.291~4.918	0.007
hs-CRP	0.810	0.218	13.829	2.249	1.467~3.446	＜0.001
中性粒细胞	0.293	0.192	2.337	1.340	0.921~1.951	0.126
PLT	0.023	0.006	15.684	1.023	1.012~1.035	＜0.001
淋巴细胞	-1.366	0.416	10.798	0.255	0.113~0.576	0.001
PLR	0.030	0.007	19.764	1.030	1.017~1.044	＜0.001
LAD	0.202	0.048	17.996	1.224	1.115~1.343	＜0.001

References 21

1	Camm AJ, Lip GY, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association [J]. Eur Heart J, 2012, 33(21): 2719-2747.
2	黄从新, 张澍, 黄德嘉, 等. 心房颤动: 目前的认识和治疗建议(2018) [J]. 中华心律失常学杂志, 2018, 22(4): 279-346.
3	Zhang XY, Yu RH, Dong JZ. Clinical characteristics and efficacy of radiofrequency catheter ablation in the treatment of elderly patients with atrial fibrillation [J]. Am J Med Sci, 2017, 355(4): 357-361.
4	Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design [J]. Heart Rhythm, 2012, 9(4): 632-696.
5	Pallisgaard JL, Gislason GH, Hansen J, et al. Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014: a nationwide Danish cohort study [J]. Eur Heart J, 2018, 39(6): 442-449.
6	Van Wagoner DR, Chung MK. Inflammation, inflammasome activation, and atrial fibrillation [J]. Circulation, 2018, 138(20): 2243-2246.
7	Balta S, Ozturk C. The platelet-lymphocyte ratio: a simple, inexpensive and rapid prognostic marker for cardiovascular events [J]. Platelets, 2015, 26(7): 680-681.
8	January CT, Wann LS, Alpert JS, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: executive summary: a report of the American college of cardiology/American heart association task force on practice guidelines and the Heart Rhythm Society [J]. J Am Coll Cardiol, 2014, 130(23): 2071-2104.
9	Kuck KH, Brugada J, Fürnkranz A, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation [J]. N Engl J Med, 2016, 374(23): 2235-2245.
10	Ciuffo L, Tao S, Ipek E G, et al. Intra-atrial dyssynchrony during sinus rhythm predicts recurrence after the first catheter ablation for atrial fibrillation [J]. JACC Cardiovasc Imaging, 2018, 12(2): 310-319.
11	Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: a cohort study [J]. Lancet, 2015, 386(9989): 154-162.
12	Wolowacz SE, Samuel M, Brennan VK, et al. The cost of illness of atrial fibrillation: a systematic review of the recent literature [J]. Europace, 2011, 13(10): 1375-1385.
13	Haegeli LM, Calkins H. Catheter ablation of atrial fibrillation: an update [J]. Eur Heart J, 2014, 35(36): 2454-2459.
14	Kornej J, Schumacher K, Sommer P, et al. Very late arrhythmia recurrences in patients with sinus rhythm within the first year after catheter ablation: the Leipzig heart center AF ablation registry [J]. Europace, 2019, 21(11): 1646-1652.
15	Marrouche NF, Wilber D, Hindricks G, et al. Association of atrial tissue fibrosis identified by selayed enhancement MRI and atrial fibrillation catheter ablation: the DECAAF study [J]. JAMA, 2014, 311(5): 498-506.
16	Köroğlu S, Tuncer C, Acar G, et al. Relation of inflammatory and oxidative markers to the occurrence and recurrence of persistent atrial fibrillation [J]. Turk Kardiyol Dern Ars, 2012, 40(6): 499-504.
17	Frustaci A, Chimenti C, Bellocci F, et al. Histological substrate of atrial biopsies in patients with lone atrial fibrillation [J]. Circulation, 1997, 96(4): 1180-1184.
18	Hu YF, Chen YJ, Lin YJ, et al. Inflammation and the pathogenesis of atrial fibrillation [J]. Nat Rev Cardiol, 2015, 12(4): 230-243.
19	Kurtul A, Murat SN, Yarlioglues M,et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes [J]. J Am Coll Cardiol, 2014, 114(7): 972-978.
20	Gary T, Pichler M, Belaj K, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients [J]. PLoS One, 2013, 8(7): e67688.
21	Gungor H, Babu AS, Zencir C, et al. Association of preoperative platelet-to-lymphocyte ratio with atrial fibrillation after coronary artery bypass graft surgery [J]. Med Princ Pract, 2017, 26(2): 164-168.

[1]	Danni Liu, Meng Ao, Haitao Ran, Shiyu Li, Fang Qin. Biatrial structure and function reverse remodelling in patients with persistent atrial fibrillation after cardioversion: evidence from three dimensional echocardiography and two dimensional speckle tracking imaging [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(08): 827-835.
[2]	Yumeng Zheng, Mingyan Ding, Dandan Sun, Lijuan Guo, Huihui Zhang, Hanzhang Zhao, Fang Zhu. Evaluation of left atrium and left atrial appendage function and risk factors for thrombosis in patients with non-valvular atrial fibrillation by echocardiography [J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2023, 20(02): 207-212.
[3]	Haijian Zhao, Xin Zhao, Ning Chen, Jian Wang, Lun Zhu, Xiaoyu Zhang, Heng Li. Expression of aquaporin 3 in different states of small intestine and its clinical significance [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 342-345.
[4]	Shitong Diao, Yifan Wang, Run Dong, Jinmin Peng, Shuhua He, Li Weng, Bin Du. Comparison of the prognostic prediction of eSOFA, qSOFA, SIRS in sepsis patients: a prospective cohort study based on non-ICU inpatients [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 143-148.
[5]	Bin Sun, Zongzhao He, Hao Wang, Ting Wang, Xiaoqin Liu. A study on the correlation between the severity and inflammatory response of hypertensive intracerebral hemorrhage patients undergoing surgery in the Xining area [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 62-68.
[6]	Qinglei Wang, Wei Li, Huiwen Dong, Hailing Liu, Bo Wang, Xiangling Meng, Yabin Feng. Low-tube voltage scanning combined with reducing contrast agent dosage in pulmonary vein and left atrial angiography [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(02): 89-92.
[7]	Zhen Wang, Xiaoyue Yang, Kangkang Su, Chaoyang Wang, Shaojie Li, Shuxia Chen, Jian Gu. Progress in understanding of prognostic impact of beta-blockers on patients with heart failure and atrial fibrillation [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 479-482.
[8]	Yunhui Zhang, Jun Luo, Lili Liu, Hong Wang, Keming Geng. Effect of peritoneal dialysis and hemodialysis on nutritional status and inflammatory response in elderly patients with end-stage renal disease [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(04): 419-423.
[9]	Huixian He, Yong Xiao, Yanqin Ji. Comparison of triangular balloon and metal circular contraceptive device in patients with moderate and severe postoperative intrauterine adhesion [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(02): 159-164.
[10]	Zhendong Wang, Yun Li, Lingkai Jiang, Ting Wang, Yang Liu. Heart valve surgery combined with atrial fibrillation radiofrequency ablation and left atrial appendage clipping for prevention of cardiogenic stroke [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(02): 142-148.
[11]	Yuanxia Duan, Liuna Gu, Lei Zhang, Liting Zhou, Haiying Zhu, Chao Yang, Haiying Chen, Xiaoqing Gu, Zongshang Gao, Jiaoling Huang. Analysis of cognition and influencing factors of atrial fibrillation among grassroots general practitioners in Fengxian District, Shanghai [J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 154-159.
[12]	Bin Cao, Yin Guo, Panpan Xia, Jiazhen Liu, Jun Wang, Yumin Sun. Treatment strategies for non-paroxysmal atrial fibrillation: a questionnaire from cardiac electrophysiologists engaged in catheter ablation [J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 147-153.
[13]	Jianing Fan, Dawei Lin, Mingfei Li, Feng Zhang, Xiaochun Zhang, Wenzhi Pan, Daxin Zhou. Safety and efficacy of "one-stop" combining atrial septal defect and left atrial appendage closure [J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(02): 109-113.
[14]	Li’na Chen, Yihua Yu, Liang Xu, Shijin Gong, Yueben Wang. Predictive value of neutrophil/lymphocyte ratio and C-reactive protein/lymphocyte ratio for 28-day mortality in elderly patients with sepsis [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2023, 10(02): 28-32.
[15]	Lingzhi Qiu, Ping Hu, Ting Luo, Hua Yan. Research progress of the relationship between lipoprotein(a) and atrial fibrillation [J]. Chinese Journal of Cerebrovascular Diseases(Electronic Edition), 2023, 17(03): 280-284.

Please choose a citation manager

Content to export