The prognostic value of monocyte/ high-density lipoprotein ratio in chronic heart failure
Authors: Silva C.M , Ferrao D , Soares P.R , Nogueira F , Oliveira D.M , Ferreira A.I , Silva J.E , Lume M.J , Melo N , Pereira J , Lourenco P , Araujo J.P 
Published: October 2021

Abstract

Background
The monocyte-high density lipoprotein ratio (MHR) is an inflammation marker that combines monocyte counts, increased in inflammatory states, and high-density lipoprotein (HDL) levels, that appear to have protective and anti-inflammatory properties. It has been studied in chronic kidney disease, primary hypertension, cerebrovascular disease and coronary artery disease (CAD), and has been shown to be positively correlated with disease severity and worse prognosis. Although inflammation is thought to be implicated in heart failure's (HF) pathophysiology, little is known about the role of MHR in the HF setting.

Purpose
To study the prognostic impact of MHR in chronic HF.

Methods
We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. Patients with no data on monocyte counts or HDL levels in the first appointment were excluded. Endpoint under analysis: all-cause mortality. Patients were categorized according to MHR quartiles: 1st quartile &lt;11, 2nd quartile ≥11 to &lt;15, 3rd quartile ≥15 to &lt;20 and 4th quartile ≥20. A Cox-regression analysis was used to assess association between MHR and all-cause mortality. A multivariate model was built adjusting for age, sex, hypertension, diabetes mellitus (DM), CAD, obstructive sleep apnea, inflammatory/autoimmune disease, atrial fibrillation, anaemia, renal dysfunction, brain-type-natriuretic peptide (BNP), New York Heart Association (NYHA) class, low-density lipoprotein value, prognostic modifying therapy and severe LVSD.

Results
We studied 560 chronic HF patients with LVSD, mean age 70±12 years, 67.5% men, 37.1% in NYHA class I, 44.8% in NYHA class II and the remaining in higher classes. Patients with MHR≥20 (last quartile) were mostly men with higher prevalence of DM and CAD, they more often presented in higher NYHA classes and with worse renal function and higher BNP. No difference existed concerning doses of evidence based-drugs. During a median follow-up of 53 (32–88) months from the index medical appointment 256 patients (45.7%) died. Mortality was similar in the lower three MHR quartiles, being statistically higher in the last quartile. Considering only two groups - MHR &lt;20 and MHR ≥20 - the all-cause mortality rate was of 41.6 vs. 57.6%, respectively, p=0,001. MHR was independently associated with poor survival. In patients presenting with MHR ≥20, the HR of long-term all-cause mortality was 1.42 (95% CI: 1.04–1.93), p=0.03 when compared with those with lower MHR.

Conclusions
Chronic HF patients with MHR ≥20 have a significant 42% increased risk of long-term all-cause death. We reinforce the role of inflammation in chronic HF. The MHR is a practical, inexpensive and widely available parameter that can help clinicians in the identification of chronic HF patients at higher risk of death.

Funding Acknowledgement
Type of funding sources: None.