Prognostic significance of Absolute Neutrophil Count in Patients with Heart Failure with Preserved Ejection Fraction

Abstract

Background: The role of inflammation and neutrophil/lymphocyte ratio has been defined in systolic heart failure (HF) and coronary artery disease, but it is uncertain if such a relationship exists in HF with preserved ejection fraction (HFpEF) patients (pts). We sought to identify the prognostic impact of Absolute Neutrophil Count (ANC) in HFpEF in the absence of coronary artery disease history (CAD Hx).Methods: In this retrospective cohort, the institutional HF data base was queried to identify HFpEF pts diagnosed in 2006 (registry initiation date) based on symptoms, BNP, and Echocardiogram with no CAD Hx. Measured outcomes were cardiovascular disease (CVD) mortality and number of HF re-admissions (poor outcome if > 2 HF re-admissions). Results: We identified 125 eligible pts. Mean age was 70.8 ± 11.7 years. Women constituted 56.6%. Mean follow up was for 8.75 ± 0.17 years. The CVD mortality rate was 7.1%. Poor outcome was identified in 52.6%. Mean ANC was 6.3 ± 3.2, and in multivariate regression analysis, including baseline demographic, clinical, and biochemical covariates, ANC remained significantly associated with poor outcome and an independent predictor of mortality (OR 1.14, 95% CI 1.02-1.29, P=0.04 after adjustment for age, sex, hypertension, and other risk factors)(table).
Conclusion: In HFpEF pts, ANC is a significant predictor of poor outcome as well as mortality in the absence of coronary artery disease. Accordingly, ANC can be utilized as one of the non-invasive prognostic markers in HFpEF patients.