The Association Between Monocyte To High-density Lipoprotein Ratio And Atrial High-rate Episodes In Patients Detected By Cardiovascular Implantable Electronic Devices

Objective: To investigate the association between the ratio of monocytes to high-density lipoprotein(M/H ratio)and new atrial high-rate episodes(AHREs)detected by cardiovascular implantable electronic devices(CIEDs).Methods:Retrospectively collecting the medical records of all patients implanted with CIEDs in the first hospital of Hebei Medical University from June 2013 to June 2018.According to the inclusion and exclusion criteria,140 patients who were diagnosed with bradycardia arrhythmia and implanted electronic devices were included in the study.The patients were followed up regularly at least 12 months.The patients were divided into M/H= <3.26group?M/H=3.26-5.00 group and M/H=>5.00 group by tertile of M/H ratio.main endpoint event of the study is AHREs detected by CIEDs during follow-up.inflammation and oxidative stress levels and baseline data were compared In different groups.The risk factors of new AHREs and stroke after CIEDs operation were analyzed by Cox proportional risk regression.Results: The median age of the patients was 70.00 years,the number of female was 78(55.7%),with an average follow-up of 39.3±24.2 months.AHREs were detected in 28 patients(20.0%)within 12 months after operation and in 44 patients(31.4%)during over 12 months follow-up.There were 3(6.5%),5(10.6%)and 20(42.6%)AHREs in the M/h =< 3.26 group,M/h =3.26-5.00 group and M/H= > 5.00 group within 12 months after operation respectively;the long-term follow-up showed that there were 10(21.7%),9(19.1%)and 25(53.2%)AHREs in the three groups respectively,which were significant statistical differences(P<0.05).Compared with the control group,the number of leukocytes,neutrophils,monocytes and M/H were significantly different in AHREs patients(P<0.05).according to Cox proportional risk regression analysis,m/h(HR: 1.445;95% CI: 1.22-1.71,P< 0.001)and the left atrial diameter(HR:1.064;95% CI: 1.01-1.13,P = 0.024)was the risk factor of new AHREs detected by CIEDs.The risk of AHREs in the M/H =>5.00 group(HR:7.246;95% CI: 2.505-20.965,P<0.001)was significantly higher than that in the other two groups.ROC curve showed that M/H(AUC: 0.717;95% CI: 0.62-0.82,P< 0.001)was superior to left atrial transverse diameter(AUC:0.600;95%CI: 0.49-0.71,P=0.058),with the cutoff value of 5.57,the sensitivity of 54.5%,and the specificity of 85.4%;in addition,the predicted value of M/h(AUC:0.807;95% CI: 0.72-0.90,P< 0.001)within one year after operation was dramatically stronger,with the cutoff value of 4.47,the sensitivity of 85.7%,and the specificity of 67.0%.There was a correlation between M/h and left atrial transverse diameter(r = 0.321,P <0.001).Conclusion: As a new marker representing the level of inflammation and oxidative stress in serum,M/H is a risk factor of new onset of AHREs in patients detected by CIEDs.And it has predictive value,of which predictive value may be slightly weakened in the long-term follow-up.