Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis

Antonio Cannata; Amitai Segev; Cristina Madaudo; Emanuele Bobbio; Chiara Baggio; Jonathan Schütze; Piero Gentile; Marta Sanguineti; Luca Monzo; Matteo Schettino; Emma Ferone; Ahmed Elshanoury; Anan Younis; Matteo Palazzini; Adriana Ferroni; Valentina Giani; Matthew Sadler; Daniela Di Lisi; Mohammad Albarjas; Leonardo Calò; Daniel Sado; Christian Lars Polte; Andrea Garascia; Paul A. Scott; Ajay M. Shah; Mauro Giacca; Gianfranco Sinagra; Entela Bollano; Theresa McDonagh; Carsten Tschöpe; Giuseppina Novo; Enrico Ammirati; Roy Beigel; Christoph Gräni; Marco Merlo; Pietro Ameri; Daniel I. Bromage

doi:10.1016/j.jchf.2024.11.003

Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis

Antonio Cannata^*, Amitai Segev, Cristina Madaudo, Emanuele Bobbio, Chiara Baggio, Jonathan Schütze, Piero Gentile, Marta Sanguineti, Luca Monzo, Matteo Schettino, Emma Ferone, Ahmed Elshanoury, Anan Younis, Matteo Palazzini, Adriana Ferroni, Valentina Giani, Matthew Sadler, Daniela Di Lisi, Mohammad Albarjas, Leonardo CalòDaniel Sado, Christian Lars Polte, Andrea Garascia, Paul A. Scott, Ajay M. Shah, Mauro Giacca, Gianfranco Sinagra, Entela Bollano, Theresa McDonagh, Carsten Tschöpe, Giuseppina Novo, Enrico Ammirati, Roy Beigel, Christoph Gräni, Marco Merlo, Pietro Ameri, Daniel I. Bromage

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

Abstract

Background: Neutrophil-to-lymphocyte ratio (NLR) is an easy-to-use inflammatory biomarker. Baseline NLR is independently associated with incident cardiovascular events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. Objectives: The present study aimed to investigate the prognostic value of NLR in patients with AM. Methods: A total of 1,150 consecutive patients with a diagnosis of AM admitted to 10 international tertiary referral cardiac centers were included in the study. The diagnosis was confirmed using cardiac magnetic resonance or endomyocardial biopsy. The primary outcome measure was a composite of all-cause mortality or heart transplantation. Patients were divided into 2 groups according to an NLR cutoff of 4 derived from spline regression analysis and 70:30 train-test split algorithm. Results: Patients with an NLR <4 were younger and more likely to present with chest pain, and those with an NLR ≥4 were more likely to present with breathlessness and have other comorbidities. Over a median follow-up of 228 weeks, a NLR ≥4 was associated with a worse prognosis (P < 0.0001). After adjustment for prognostic variables, NLR emerged as an independent predictor of outcome (HR: 3.03 [95% CI: 1.30-7.04]; P = 0.010). Elevated NLR remained associated with worse outcomes among patients with preserved ejection fraction at baseline, who are conventionally considered to be at lower risk of adverse events (P < 0.0001). Conclusions: In patients with AM, elevated NLR is associated with worse prognosis and may be valuable for stratifying patients, even those conventionally considered at low risk.

Original language	English
Journal	JACC: Heart Failure
DOIs	https://doi.org/10.1016/j.jchf.2024.11.003
Publication status	Accepted/In press - 6 Nov 2024

Keywords

immunosuppression
lymphocyte
myocarditis
neutrophil
neutrophil-to-lymphocyte ratio
outcomes

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10.1016/j.jchf.2024.11.003

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Cannata, A., Segev, A., Madaudo, C., Bobbio, E., Baggio, C., Schütze, J., Gentile, P., Sanguineti, M., Monzo, L., Schettino, M., Ferone, E., Elshanoury, A., Younis, A., Palazzini, M., Ferroni, A., Giani, V., Sadler, M., Di Lisi, D., Albarjas, M., ... Bromage, D. I. (Accepted/In press). Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis. JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2024.11.003

@article{941341ec5392426ba41ae83160510b27,

title = "Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis",

abstract = "Background: Neutrophil-to-lymphocyte ratio (NLR) is an easy-to-use inflammatory biomarker. Baseline NLR is independently associated with incident cardiovascular events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. Objectives: The present study aimed to investigate the prognostic value of NLR in patients with AM. Methods: A total of 1,150 consecutive patients with a diagnosis of AM admitted to 10 international tertiary referral cardiac centers were included in the study. The diagnosis was confirmed using cardiac magnetic resonance or endomyocardial biopsy. The primary outcome measure was a composite of all-cause mortality or heart transplantation. Patients were divided into 2 groups according to an NLR cutoff of 4 derived from spline regression analysis and 70:30 train-test split algorithm. Results: Patients with an NLR <4 were younger and more likely to present with chest pain, and those with an NLR ≥4 were more likely to present with breathlessness and have other comorbidities. Over a median follow-up of 228 weeks, a NLR ≥4 was associated with a worse prognosis (P < 0.0001). After adjustment for prognostic variables, NLR emerged as an independent predictor of outcome (HR: 3.03 [95% CI: 1.30-7.04]; P = 0.010). Elevated NLR remained associated with worse outcomes among patients with preserved ejection fraction at baseline, who are conventionally considered to be at lower risk of adverse events (P < 0.0001). Conclusions: In patients with AM, elevated NLR is associated with worse prognosis and may be valuable for stratifying patients, even those conventionally considered at low risk.",

keywords = "immunosuppression, lymphocyte, myocarditis, neutrophil, neutrophil-to-lymphocyte ratio, outcomes",

author = "Antonio Cannata and Amitai Segev and Cristina Madaudo and Emanuele Bobbio and Chiara Baggio and Jonathan Sch{\"u}tze and Piero Gentile and Marta Sanguineti and Luca Monzo and Matteo Schettino and Emma Ferone and Ahmed Elshanoury and Anan Younis and Matteo Palazzini and Adriana Ferroni and Valentina Giani and Matthew Sadler and {Di Lisi}, Daniela and Mohammad Albarjas and Leonardo Cal{\`o} and Daniel Sado and Polte, {Christian Lars} and Andrea Garascia and Scott, {Paul A.} and Shah, {Ajay M.} and Mauro Giacca and Gianfranco Sinagra and Entela Bollano and Theresa McDonagh and Carsten Tsch{\"o}pe and Giuseppina Novo and Enrico Ammirati and Roy Beigel and Christoph Gr{\"a}ni and Marco Merlo and Pietro Ameri and Bromage, {Daniel I.}",

note = "Publisher Copyright: {\textcopyright} 2025 The Authors",

year = "2024",

month = nov,

day = "6",

doi = "10.1016/j.jchf.2024.11.003",

language = "English",

journal = "JACC: Heart Failure",

issn = "2213-1779",

publisher = "Elsevier BV",

}

Cannata, A, Segev, A, Madaudo, C, Bobbio, E, Baggio, C, Schütze, J, Gentile, P, Sanguineti, M, Monzo, L, Schettino, M, Ferone, E, Elshanoury, A, Younis, A, Palazzini, M, Ferroni, A, Giani, V, Sadler, M, Di Lisi, D, Albarjas, M, Calò, L, Sado, D, Polte, CL, Garascia, A, Scott, PA, Shah, AM , Giacca, M, Sinagra, G, Bollano, E, McDonagh, T, Tschöpe, C, Novo, G, Ammirati, E, Beigel, R, Gräni, C, Merlo, M, Ameri, P & Bromage, DI 2024, 'Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis', JACC: Heart Failure. https://doi.org/10.1016/j.jchf.2024.11.003

TY - JOUR

T1 - Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis

AU - Cannata, Antonio

AU - Segev, Amitai

AU - Madaudo, Cristina

AU - Bobbio, Emanuele

AU - Baggio, Chiara

AU - Schütze, Jonathan

AU - Gentile, Piero

AU - Sanguineti, Marta

AU - Monzo, Luca

AU - Schettino, Matteo

AU - Ferone, Emma

AU - Elshanoury, Ahmed

AU - Younis, Anan

AU - Palazzini, Matteo

AU - Ferroni, Adriana

AU - Giani, Valentina

AU - Sadler, Matthew

AU - Di Lisi, Daniela

AU - Albarjas, Mohammad

AU - Calò, Leonardo

AU - Sado, Daniel

AU - Polte, Christian Lars

AU - Garascia, Andrea

AU - Scott, Paul A.

AU - Shah, Ajay M.

AU - Giacca, Mauro

AU - Sinagra, Gianfranco

AU - Bollano, Entela

AU - McDonagh, Theresa

AU - Tschöpe, Carsten

AU - Novo, Giuseppina

AU - Ammirati, Enrico

AU - Beigel, Roy

AU - Gräni, Christoph

AU - Merlo, Marco

AU - Ameri, Pietro

AU - Bromage, Daniel I.

PY - 2024/11/6

Y1 - 2024/11/6

N2 - Background: Neutrophil-to-lymphocyte ratio (NLR) is an easy-to-use inflammatory biomarker. Baseline NLR is independently associated with incident cardiovascular events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. Objectives: The present study aimed to investigate the prognostic value of NLR in patients with AM. Methods: A total of 1,150 consecutive patients with a diagnosis of AM admitted to 10 international tertiary referral cardiac centers were included in the study. The diagnosis was confirmed using cardiac magnetic resonance or endomyocardial biopsy. The primary outcome measure was a composite of all-cause mortality or heart transplantation. Patients were divided into 2 groups according to an NLR cutoff of 4 derived from spline regression analysis and 70:30 train-test split algorithm. Results: Patients with an NLR <4 were younger and more likely to present with chest pain, and those with an NLR ≥4 were more likely to present with breathlessness and have other comorbidities. Over a median follow-up of 228 weeks, a NLR ≥4 was associated with a worse prognosis (P < 0.0001). After adjustment for prognostic variables, NLR emerged as an independent predictor of outcome (HR: 3.03 [95% CI: 1.30-7.04]; P = 0.010). Elevated NLR remained associated with worse outcomes among patients with preserved ejection fraction at baseline, who are conventionally considered to be at lower risk of adverse events (P < 0.0001). Conclusions: In patients with AM, elevated NLR is associated with worse prognosis and may be valuable for stratifying patients, even those conventionally considered at low risk.

AB - Background: Neutrophil-to-lymphocyte ratio (NLR) is an easy-to-use inflammatory biomarker. Baseline NLR is independently associated with incident cardiovascular events and all-cause mortality. However, whether this applies to acute myocarditis (AM) has not been evaluated. Objectives: The present study aimed to investigate the prognostic value of NLR in patients with AM. Methods: A total of 1,150 consecutive patients with a diagnosis of AM admitted to 10 international tertiary referral cardiac centers were included in the study. The diagnosis was confirmed using cardiac magnetic resonance or endomyocardial biopsy. The primary outcome measure was a composite of all-cause mortality or heart transplantation. Patients were divided into 2 groups according to an NLR cutoff of 4 derived from spline regression analysis and 70:30 train-test split algorithm. Results: Patients with an NLR <4 were younger and more likely to present with chest pain, and those with an NLR ≥4 were more likely to present with breathlessness and have other comorbidities. Over a median follow-up of 228 weeks, a NLR ≥4 was associated with a worse prognosis (P < 0.0001). After adjustment for prognostic variables, NLR emerged as an independent predictor of outcome (HR: 3.03 [95% CI: 1.30-7.04]; P = 0.010). Elevated NLR remained associated with worse outcomes among patients with preserved ejection fraction at baseline, who are conventionally considered to be at lower risk of adverse events (P < 0.0001). Conclusions: In patients with AM, elevated NLR is associated with worse prognosis and may be valuable for stratifying patients, even those conventionally considered at low risk.

KW - immunosuppression

KW - lymphocyte

KW - myocarditis

KW - neutrophil

KW - neutrophil-to-lymphocyte ratio

KW - outcomes

UR - http://www.scopus.com/inward/record.url?scp=85217226357&partnerID=8YFLogxK

U2 - 10.1016/j.jchf.2024.11.003

DO - 10.1016/j.jchf.2024.11.003

M3 - Article

C2 - 39846908

AN - SCOPUS:85217226357

SN - 2213-1779

JO - JACC: Heart Failure

JF - JACC: Heart Failure

ER -

Elevated Neutrophil-to-Lymphocyte Ratio Predicts Prognosis in Acute Myocarditis

Abstract

Keywords

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