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Role of Beta Blockers in Inflammatory Response During Acute Heart Failure

Published:October 28, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.10.002
      We read with interest the article by Davison et al entitled “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).” In this study, the authors showed that the neutrophil-to-lymphocyte ratio, a readily available inflammatory biomarker, was better associated with independent risk for short- and long-term adverse outcomes in acute heart failure than were traditional markers such as natriuretic peptides.
      • Davison BA
      • Takagi K
      • Edwards C
      • Adams Jr, 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).
      Inflammation plays a significant role in cardiovascular disease pathogenesis in both acute and chronic settings. Furthermore, this study supports the previous studies in patients with acute heart failure and acute coronary syndrome conducted by our study group.
      • Demir M
      • Duyuler PT
      • Guray U
      • Celik MC.
      Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema.
      ,
      • Korkmaz A
      • Yildiz A
      • Gunes H
      • Duyuler S
      • Tuncez A.
      Utility of neutrophil-lymphocyte ratio in predicting troponin elevation in the emergency department setting.
      In this context, we believe that this study provides additional insight into the pathophysiology underlying acute heart failure and has a prognostic value in the management of patients with acute heart failure. In contrast, some points deserve further elucidation. As the authors underlined in the article, leukocytes are influenced by sympathetic nerve system response. In this way, ꞵ blockers are widely used cardiovascular drugs with the potential to modify the sympathetic nerve system response to the leukocyte activation, migration, and number of cells in the peripheral circulation.
      • von Haehling S
      • Schefold JC
      • Jankowska E
      • Doehner W
      • Springer J
      • Strohschein K
      • Genth-Zotz S
      • Volk HD
      • Poole-Wilson P
      • Anker SD.
      Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure.
      ,
      • Kühlwein EC
      • Irwin MR
      • Ziegler MG
      • Woods VL
      • Kennedy B
      • Mills PJ.
      Propranolol affects stress-induced leukocytosis and cellular adhesion molecule expression.
      In this post hoc analysis including a relatively high number of patients, a remarkable proportion of the patients had ischemic heart disease and potentially had been using this class of medication. Although confounders like active infection were excluded from the study, status of β-blocker use was not stated. Being β-blocker naive or being on this medication may affect the neutrophil-to-lymphocyte ratio and the prognosis of acute heart failure. We propose that consideration of ꞵ-blocker use in the analysis may increase the scientific value of this appreciable study.
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      References

        • Davison BA
        • Takagi K
        • Edwards C
        • Adams Jr, 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
        • Demir M
        • Duyuler PT
        • Guray U
        • Celik MC.
        Platelet to lymphocyte ratio on admission and prognosis in patients with acute cardiogenic pulmonary edema.
        J Emerg Med. 2018; 55: 465-471
        • Korkmaz A
        • Yildiz A
        • Gunes H
        • Duyuler S
        • Tuncez A.
        Utility of neutrophil-lymphocyte ratio in predicting troponin elevation in the emergency department setting.
        Clin Appl Thromb Hemost. 2015; 21: 667-671
        • von Haehling S
        • Schefold JC
        • Jankowska E
        • Doehner W
        • Springer J
        • Strohschein K
        • Genth-Zotz S
        • Volk HD
        • Poole-Wilson P
        • Anker SD.
        Leukocyte redistribution: effects of beta blockers in patients with chronic heart failure.
        PLoS One. 2009; 4: e6411
        • Kühlwein EC
        • Irwin MR
        • Ziegler MG
        • Woods VL
        • Kennedy B
        • Mills PJ.
        Propranolol affects stress-induced leukocytosis and cellular adhesion molecule expression.
        Eur J Appl Physiol. 2001; 86: 135-141