Original Article

Does Absolute Neutrophilia Predict Early Congestive Heart Failure After Acute Myocardial Infarction? A Cross-Sectional Study

Authors: Farid Rashidi, MD, Arash Rashidi, MD, Ali Golmohamadi, MD, Eslam Hoseinzadeh, MD, Behzad Mohammadi, MD, Houra Mirzajani, MD, Marziah Kheiri, RN, Peiman Jamshidi, MD

Abstract

Background: Acute myocardial infarction (AMI) is usually associated with increased neutrophil count. However, it has not clearly been defined whether neutrophilia can cause myocardial injury. In this study, we hypothesized that absolute neutrophilia can predict the occurrence of congestive heart failure (CHF) after AMI.


Methods: A cross-sectional study was carried out on 312 patients with a diagnosis of AMI. Patients with a history of chest pain for more than 12 hours before admission, heart failure with Killip class III and IV, history of recent gastrointestinal bleeding, major trauma, infection, malignancy, renal failure and corticosteroid consumption were excluded. A blood sample was drawn for leukocyte count and an echocardiogram was obtained 4 days after admission. Congestive heart failure was defined as an ejection fraction less than 40% on echocardiogram or clinical heart failure according to the Framingham’s criteria for diagnosis of heart failure.


Results: After excluding 19 patients, data for 293 patients were analyzed. Among them, 152 (51.9%) patients developed new onset CHF. Two hundred and two patients (68.9%) had neutrophilia (neutrophil count >7500/mic/lit). The risk of developing heart failure was higher in patients with neutrophilia (OR = 2.32; 95% CI = 1.33–4.03, P = 0.000). There was a negative correlation between ejection fraction and neutrophil count (r = −0.191, P = 0.000). After adjustment for age, sex, serum creatinine level, peak enzyme CK-MB level and MI location, the relationship between the absolute neutrophil count and the presence of congestive heart failure remained significant (OR = 2.14; 95% CI = 1.19–3.84, P = 0.011).


Conclusions: The study shows that the presence of absolute neutrophilia during the first 12 hours after AMI can predict the occurrence of CHF. This association may help identify high-risk individuals, who might benefit from more aggressive interventions.


Key Points


* Absolute neutrophilia after acute myocardial infarction is associated with congestive heart failure.


* There is no significant relationship between relative neutrophilia (neutrophil percentage >70%) and development of congestive heart failure.


* There is a negative correlation between ejection fraction and neutrophil count after acute myocardial infarction.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Libman E. The importance of blood examinations in the recognition of thrombosis of coronary arteries and its sequelae. Am Heart J 1925;1:121–123.
 
2. Thomson Sp, gibbons RJ, Smars PA, et al. Intermantal value of the leuekocyte differential and the rapid creatine kinase-MB isoenzyme for the early diagnosis of myocardial infraction. Ann Intern Med 1995;122: 335–341.
 
3. Friedman GD, Klastsky AL, Siegelaub AB. The leukocyte count as a predictor of myocardial infarction. N Engl J Med 1974;290:1275–1278.
 
4. Burr ML, Holliday RM, Fehily AM, et al. Haematological prognostic incidences after myocardial infarction: evidence from the Diet and Reinfarction Trial (DART). Eur Heart J 1992;13:166–170.
 
5. Fresco C, Carinci F, on behalf of the GISSI Investigators. Very early assessment of risk for in hospital death among 11,483 patients with acute myocardial infarction. Am Heart J 1999;138:1058–1064.
 
6. Ho KKL, Pinsky JL, Kannel WB, et al. The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 1993;22(suppl A):6A–13A.
 
7. Heart Failure Guidelines. Agency for Health Care Policy and Research publication No. 94-006612, Rockville, MD;US Department of health and human services: June 1994.
 
8. Kaul N, Siveski M, Hill M, et al. Free radicals and the heart. J Pharmacol Toxicol Methods 1993;30:55–67.
 
9. Giugliano D, Ceriello A, Paolisso G. Diabets mellitus, hypertension, and cardiovascular disease: which role for oxidative stress. Metabolism 1995;44:363–368.
 
10. Ypil WM, Tria R, Abad SJ. Absolute neutrophilia as predictor for the development of early onset congestive heart failure in patients admitted for acute myocardial infarction. PJCVN 2002;30:101–106.
 
11. Ali AS, Rybicki B, Alam M. Clinical predictors of heart failure in patients with first acute myocardial infarction. Am Heart J 1999;138:1133–1139.
 
12. Killip T, Kimball JT. Treatment of myocardial infarction in a coronary care unit: a two year experience of 250 patients. Am J Cardiol 1967;20:457–464.
 
13. McKee PA, Castelli WP, McNamara PM, et al. The natural history of congestive heart failure: the Framingham study. N Engl J Med 1971;285:1441–1446.
 
14. Furman MI, Becker RC, Yarzebski J, et al. Effect of elevated leukocyte count on in-hospital mortality following acute myocardial infarction. Am J Cardiol 1996;78:945–948.
 
15. Furman MI, Gore JM, Anderson FA, et al, GRACE Investigators. Elevated leukocyte count and adverse hospital events in patients with acute coronary syndromes: findings from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2004;147:42–48.
 
16. Barron HV, Cannon CP, Murphy SA, et al. Association between white blood cell count, epicardal blood flow, myocardial perfusion, and clinical outcomes in the setting of acute myocardial infarction: Thrombolysis In Myocardial Infarction 10 substudy. Circulation 2000;102:2329–2334.
 
17. Lucchesi BR, Werns SW, Fantone JC. The role of the neutrophil and free radical in ischemic myocardial injury. J Mol Cell Cardiol 1989;21: 1241–1251.
 
18. Jolly SR, Kane WJ, Hook BG, et al. Reduction of myocardial infarct size by neutrophil depletion: effect of duration of occlusion. Am Heart J 1986;112:682–690.
 
19. Mehta JL, Nichols WW, Mehta P. Neutrophils as potential participants in acute myocardial ischemia: relevance to reperfusion. J Am Coll Cardiol 1988;11:1309–1316.
 
20. Engler RL, Schmid-Schonbein GW, Paveles RS. Leukocute capillary plugging in myocardial ischemia and reperfusion in the dog. Am J Pathol 1983;111:98–111.
 
21. Hansen PR. Role neutrophols in myocardial ischemia and reperfusion. Circulation 1995;91:1872–1885.
 
22. Ferrante RJ, Hobson RW 2nd, Miysaka M, et al. Inhibition of white blood cell adhesion at reperfusion decreases tissue damage in postischemic striated muscle. J Vasc Surg 1996;24:187–193.
 
23. de Cavanagh EM, Fraga CG, Ferder L, et al. Enalapril and Captopril enhance ontioxident defenses in mouse tissue. Am J Physiol Regulatory Integrative Comp Physiol 1997;272:514–518.
 
24. Bartosz M, Kedziora J, Bartosz G. Antioxdant properties of captopril. Free Radic Biol Med 1997;23:729–735.
 
25. Soejima H, Ogava H, Yasue H, et al. Angiotensin-converting enzyme inhibitor reduces monocyte chemo attractant protein-1 and tissue factor levels in patients with myocardial infarction. J Am Coll Cardiol 1999;34:983–988.
 
26. Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients: the Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000;342:145–153.
 
27. Kyne L, Hausdorff JM, Knight E, et al. Neutrophilia and congestive heart failure after acute myocardial infarction. Am Heart J 2000;139:94:100.
 
28. Suleiman M, Khatib R, Agmon Y, et al. Early inflammation and risk of long-term development of heart failure and mortality in survivors of acute myocardial infarction. J Am Coll Cardiol 2006;47:962–968.
 
29. Dhalla AR, Hill MF, Singal PK. Role of oxidative stress in transition of hypertrophy to heart failure. J Am Coll Cardiol 1996;28:506–514.
 
30. Hill MF, Singal PK. Right and left myocardial antioxidant responses during heart failure subsequent to myocardial infarction. Circulation 1997;96:2414–2420.
 
31. Marx N, Neuman Fj, Ott L, et al. Induction of cytokine expression in leukocytes in acute myocardial infarction. J Am Coll Cardiol 1997;30:165–170.
 
32. Wagner DR, Metiernan C, Sanders VJ, et al. Adenosine inhibits lipopolysacharide–induced secretion of tumor necrosis factor-alpha in the failing heart. Circulation 1998;97: 521–524.
 
33. Katz AM, Katz PB. Disease of the heart in works of Hippocrates. Br Heart J 1962;24:257–264.
 
34. Vasan RS, Sullivan LM, Roubenoff R, et al. Inflammatory Markers and Risk of Heart Failure in Elderly Subjects Without Prior Myocardial Infarction: The Framingham Heart Study Circulation 2003;107:1486–1491.
 
35. Maekawa Y, Anzai T, Yoshikawa T, et al. Prognostic significance of peripheral Monocytosis after reperfuses acute myocardial infarction: a possible role for left ventricular remodeling. J Am Coll Cardiol 2002;39: 241–246.
 
36. Nian M, Lee P, Khaper N, et al. Inflammatory cytokines and postmyocadial infarction remodeling. Circ Res 2004;94:1543–1553.
 
37. Valgimigli M, Ceconi C, Malaguti P, et al. Tumor necrosis factor-alpha receptor 1 is a major predictor of morality and new-onset heart failure in patients with acute myocardial infarction: the Cytokinase-Activation and Long-Term Prognosis in Myocardial Infarction (C-ALPHA) study. Circulation 2005;111:863–870.
 
38. Deten A, Volz HC, Briest W, et al. Cardiac cytokine expression is upregulated in the acute phase after myocardial infarction: experimental studies in rats. Cardiovasc Res 2002;55:329–340.
 
39. Irwin MW, Mak S, Mann DL, et al. Tissue expression and immunolocalization of tumor necrosis factor-alpha in postinfarction dysfunction myocardium. Circulation 1999;99:1492–1498.