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Role of β Blockers in Inflammatory Response During Acute Heart Failure

Published:October 29, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.10.001
      We appreciate the interest shown by Dr. Duyuler et al in our study, which examined the impact of the neutrophil-to-lymphocyte ratio (NLR) on short- and long-term adverse outcomes in patients with acute heart failure (HF).
      • Davison BA
      • Takagi K
      • Edwards C
      • Adams KF
      • Butler J
      • Collins SP
      • Dorobantu MI
      • Ezekowitz JA
      • Filippatos G
      • Greenberg BH
      • Levy PD
      • Masip J
      • Metra M
      • Pang PS
      • Ponikowski P
      • Severin TM
      • Teerlink JR
      • Teichman SL
      • Voors AA
      • Werdan K
      • Cotter G.
      Neutrophil-to-lymphocyte ratio and outcomes in patients admitted for acute heart failure (as seen in the BLAST-AHF, pre-RELAX-AHF, and RELAX-AHF studies).
      They question whether the prognostic value of the NLR might be affected by β-blocker use. We conducted additional analyses considering the reported use of oral β blockers at admission within the reported study population. Of the total 2,010 patients, 1,191 (59.3%) were taking a β blocker at the time of admission. Patients taking β blockers were younger; were more often enrolled in Western Europe or North America; had a lower New York Heart Association class before admission; less often had asthma, bronchitis, or chronic obstructive pulmonary disease and more often ischemic heart disease; had lower mean systolic blood pressure, lower mean heart rate, higher mean albumin, higher total bilirubin, lower total cholesterol, lower troponin, and lower white blood cell count. No significant difference in NLR at baseline was observed between patients with and without reported β-blocker use at admission (5.17 ± 4.35 vs 5.35 ± 4.45, p = 0.20). Associations of NLR with outcomes additionally adjusted for β-blocker use were similar to results adjusted for covariates already identified (results changed slightly with the addition of β-blocker use to the multiple imputation models) and show that NLR was significantly associated with dyspnea visual analog scale area under the curve through day 5 (mean difference per doubling of NLR −126.56, p = 0.044 vs −127.86, p = 0.0422), 30-day all-cause mortality (hazard ratio [HR] 1.58, p <0.001 vs 1.58, p = 0.001), 60-day HF or renal failure rehospitalizations or cardiovascular death (HR 1.35, p <0.001 vs 1.35, p <0.001), 180-day all-cause mortality (HR 1.28, p = 0.004 vs 1.27, p = 0.004), and 180-day cardiovascular death (HR 1.24, p = 0.021 vs 1.23, p = 0.021). Associations of NLR with each outcome did not differ significantly between patients with and without reported β-blocker use. In summary, the NLR was independently associated at risk of short- and long-term adverse outcomes in acute HF even after accounting for β-blocker use.
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      References

        • Davison BA
        • Takagi K
        • Edwards C
        • Adams KF
        • Butler J
        • Collins SP
        • Dorobantu MI
        • Ezekowitz JA
        • Filippatos G
        • Greenberg BH
        • Levy PD
        • Masip J
        • Metra M
        • Pang PS
        • Ponikowski P
        • Severin TM
        • Teerlink JR
        • Teichman SL
        • Voors AA
        • Werdan K
        • Cotter G.
        Neutrophil-to-lymphocyte ratio and outcomes in patients admitted for acute heart failure (as seen in the BLAST-AHF, pre-RELAX-AHF, and RELAX-AHF studies).
        Am J Cardiol. 2022; 180: 72-80