ABC | Volume 112, Nº1, January 2019

Original Article Assessment of the Relationship between Monocyte to High-Density Lipoprotein Ratio and Myocardial Bridge Asim Enhos, 1 Kahraman Cosansu, 2 Mustafa Ahmet Huyut, 3 Fahrettin Turna, 2 Erdem Karacop, 1 Nijad Bakshaliyev, 1 Aydin Nadir, 1 Ramazan Ozdemir, 1 Mahmut Uluganyan 1 Bezmialem University, 1 Istanbul – Turkey Sakarya Educational and Research Hospital, 2 Istanbul – Turkey Bezmialem University, 3 Istanbul – Turkey Mailing Address: Mahmut Uluganyan • Bezmialem Vakif University - Vatan Caddesi. Fatif. 34093, Istanbul – Turkey E-mail: uluganyan@yahoo.com , uluganyan@gmail.com Manuscript received January 22, 2018, revised manuscript June 19, 2018, accepted August 02, 2018 DOI: 10.5935/abc.20180253 Abstract Background: Assessing the monocyte to high-density lipoprotein ratio (MHR) is a new tool for predicting inflamation, which plays a major role in atherosclerosis. Myocardial bridge (MB) is thought to be a benign condition with development of atherosclerosis, particularly at the proximal segment of the brigde. Objective: To evaluate the relationhip between MHR and the presence of MB. Methods: We consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary artery were enrolled in the study. The patients’ angiographic, demographic and clinic characteristics of the patients were reviewed frommedical records. Monocytes and HDL-cholesterols were measured via complete blood count. MHR was calculated as the ratio of the absolute monocyte count to the HDL-cholesterol value. MHR values were divided into three tertiles as follows: lower (8.25 ± 1.61), moderate (13.11 ± 1.46), and higher (21.21 ± 4.30) tertile. A p-value of < 0.05 was considered significant. Results: MHR was significantly higher in the MB group compared to the control group with normal coronary arteries. We found the frequency of MB (p = 0.002) to increase as the MHR tertiles rose. The Monocyte-HDL ratio with a cut‑point of 13.35 had 59% sensitivity and 65.0% specificity (ROC area under curve: 0.687, 95% CI: 0.606–0.769, p < 0.001) in accurately predicting a MB diagnosis. In the multivariate analysis, MHR (p = 0.013) was found to be a significant independent predictor of the presence of MB, after adjusting for other risk factors. Conclusion: The present study revealed a significant correlation between MHR and MB. (Arq Bras Cardiol. 2019; 112(1):12-17) Keywords: Biomarkers/blood; Cholesterol, HDL/blood;Monocytes/citology;Myocardial Bridging; Atherosclerosis; Inflammation. Introduction Myocardial bridge (MB), which was described early in the cardivascular literature, is an anatomical variation characterized by the narrowing of some of the epicardial coronary arterial segments during systole. MB, also known as muscular bridge, is a rare congenital disease with a relatively good prognosis. 1-3 It has an estimated frequency of 0.5-2.5% in angiographic series, and it frequently involves the left anterior descending artery. 1 Although it is considered a benign anomaly, it may lead to complications such as angina pectoris, acute myocardial infarction, coronary spasm, arrhythmias, syncope, and sudden cardiac death. 4,5 Systolic compression of the epicardial artery is visible on angiographic imaging. Diagnosis can be made using quantitative angiography, intracoronary ultrasound, or Doppler flow measurement. 6-8 Monocyte activation has been known to play an important role in chronic inflammation and cardiovascular disease, in whichmonocytes and differentiatedmacrophages canmodulate inflammatory cytokines. 9 HDL is highly effective at inhibiting the endothelial expression of adhesion molecules and preventing monocyte recruitment to the artery wall. 9 Therefore, while monocytes exert a proinflammatory effect, HDL functions as a reversal factor during this process. Monocyte to HDL‑cholesterol ratio (MHR) is a simple assessment method for inflammatory status. 10 MHR has also been reported as a new prognostic marker in cardiovascular diseases. It is known that atherosclerosis is an inflammatory process and that MHR is a simple tool for assessing proinflamatory status. 9,10 Atherosclerosis has been shown to develop especially at the proximal and distal segments of MB in most patients. 11-13 In the present study, we evaluate the association betweenMHR andMB. Methods Study Population We consecutively scanned patients referred for coronary angiography between January 2013- December 2016, and a total of 160 patients who had a MB and normal coronary 12