The relationship between neutrophil to lymphocyte ratio and myocardial bridge


  • Ekrem Aksu Department of Cardiology, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras
  • Deniz Avci Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri
  • Gurkan Cikim Department of Biochemistry, Kahramanmaras Necip Fazil City Hospital, Kahramanmaras



Atherosclerosis, Inflammation, MB, Neutrophil-lymphocyte ratio


Background: Although myocardial bridge (MB) is a benign congenital anomaly, clinical trials have shown it to cause increased risk of atherosclerosis, which is a low-grade chronic inflammatory disease. The neutrophil-lymphocyte ratio (NLR) is an inflammatory indicator for mortality and morbidity in atherosclerotic heart disease. In this study, NLR was investigated in patients with MB.

Methods: A retrospective evaluation was made of patients admitted to our clinic for coronary angiography from 01st January 2014 to 31st December 2015. Patients included in the study were those diagnosed with MB and no evidence of atherosclerosis after coronary angiography and patients diagnosed with normal coronary vascularity. The NLR was calculated from the biochemical and hematological parameters based on the results of pre-angiographic values.

Results: Evaluation was made of 53 patients with MB (mean age: 56.70±11.45 years, 73.6% male), and 59 patients with normal coronary vascularity (mean age: 52.25±12.42 years, 39% male). No significant difference was determined between the groups in respect of biochemical or hematological parameters or in NLR values (2.34±0.88 versus 2.56±1.66; p=0.384).

Conclusions: The results of this study showed no relationship between MB and the inflammatory indicator of NLR.


Faruqui AM, Maloy WC, Felner JM, Schlant RC, Logan WD, Symbas P. Symptomatic myocardial bridging of coronary artery. Am J Cardiol. 1978;41:1305-10.

Soran O, Pamir G, Erol C, Kocakavak C, Sabah I. The incidence and significance of myocardial bridge in a prospectively defined population of patients undergoing coronary angiography for chest pain. Tokai J Exp Clin Med. 2000;25:57-60.

Kosinski A, Grzybiak M. Myocardial bridges in the human heart: morphological aspects. Folia Morphol. 2001;60:65-8.

Feld H, Guadanino V, Hollander G, Greengart A, Lichstein E, Shani J. Exercise-induced ventricular tachycardia in association with a myocardial bridge. Chest. 1991;99:1295-6.

Yano K, Yoshino H, Taniuchi M, Kachi E, Shimizu H, Watanuki A, et al. Myocardial bridging of the left anterior descending coronary artery in acute inferior wall myocardial infarction. Clin Cardiol. 2001;24:202-8.

Bhat T, Teli S, Rijal J, Bhat H, Raza M, Khoueiry G, et al. Neutrophil to lymphocyte ratio and cardiovascular diseases: a review. Exp Rev Cardiovascr Ther. 2013;11:55-9.

Ge J, Jeremias A, Rupp A, Abels M, Baumgart D, Liu F, et al. New signs characteristic of myocardial bridging demonstrated by intracoronary ultrasound and Doppler. Eur Heart J. 1999;20:1707-16.

Ge J, Erbel R, Gorge G, Haude M, Meyer J. High wall shear stress proximal to myocardial bridging and atherosclerosis: intracoronary ultrasound and pressure measurements. Br Heart J. 1995;73:462-5.

Caro CG, Fitz-Gerald JM, Schroter RC. Atheroma and arterial wall shear. Observation, correlation and proposal of a shear dependent mass transfer mechanism for atherogenesis. Proceedings of the Royal Society of London. Series B, Containing papers of a Biological character. Royal Society. 1971;177:109-59.

Ishikawa Y, Ishii T, Asuwa N, Masuda S. Absence of atherosclerosis evolution in the coronary arterial segment covered by myocardial tissue in cholesterol-fed rabbits. Virchows Archiv. 1997;430:163-71.

Scher AM. Absence of atherosclerosis in human intramyocardial coronary arteries: a neglected phenomenon. Atherosclerosis. 2000;149:1-3.

Chatzizisis YS, Giannoglou GD. Myocardial bridges spared from atherosclerosis: overview of the underlying mechanisms. Can J Cardiol. 2009;25:219-22.

Tohno Y, Tohno S, Minami T, Pakdeewong-Ongkana N, Suwannahoy P, Quiggins R. Different accumulation of elements in proximal and distal parts of the left anterior descending artery beneath the myocardial bridge. Biol Trace Elem Res. 2016;171:17-25.

Zoghi M, Duygu H, Nalbantgil S, Kirilmaz B, Turk U, Ozerkan F, et al. Impaired endothelial function in patients with myocardial bridge Echocardiography. Echocardiography. 2006;23:577-81.

Kim JW, Seo HS, Na JO, Suh SY, Choi CU, Kim EJ, et al. Myocardial bridging is related to endothelial dysfunction but not to plaque as assessed by intracoronary ultrasound. Heart. 2008;94:765-9.

Duygu H, Zoghi M, Nalbantgil S, Kirilmaz B, Türk U, Ozerkan F, et al. Myocardial bridge: a bridge to atherosclerosis. Anadolu Kardiyol Derg. 2007;7:12-6.

Ishikawa Y, Akasaka Y, Suzuki K, Fujiwara M, Ogawa T, Yamazaki K, et al. Anatomic properties of myocardial bridge predisposing to myocardial infarction. Circulation. 2009;120:376-83.

Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med. 1999;340:115-26.

Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135-43.

Zahorec R. Ratio of neutrophil to lymphocyte counts-rapid and simple parameter of systemic inflammation and stress in critically ill. Bratisl Lek Listy. 2001;102:5-14.

Gillum RF, Mussolino ME, Madans JH. Counts of neutrophils, lymphocytes, and monocytes, cause-specific mortality and coronary heart disease: the NHANES-I epidemiologic follow-up study. Ann Epidemiol. 2005;15:266-71.

Ateş AH, Canpolat U, Yorgun H, Kaya EB, Sunman H, Demiri E, et al. Total white blood cell count is associated with the presence, severity and extent of coronary atherosclerosis detected by dualsource multislice computed tomographic coronary angiography. Cardiol J. 2011;18:371-7.

Horne BD, Anderson JL, John JM, Weaver A, Bair TL, Jensen KR, et al. Which white blood cell subtypes predict increased cardiovascular risk? J Am Coll Cardiol. 2005;45:1638-43.

Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL. Usefulness of an elevated neutrophil -to- lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol. 2006;97:993-6.

Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS. Association between admission neutrophil -to- lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol. 2008;102:653-7.

Akpek M, Kaya MG, Lam YY, Şahin O, Elcik D, Çelik T, et al. Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial ınfarction undergoing primary coronary ıntervention. Am J Cardiol. 2012;110:621-7.

Papa A, Emdin M, Passino C, Michelassi C, Battaglia D, Cocci F. Predictive value of elevated neutrophil lymphocyte ratio on cardiac mortality in patients with stable coronary artery disease. Clin Chim Acta. 2008;395:27-31.

Kalay N, Dogdu O, Koc F, Yarlioglues M, Ardic I, Akpek M, et al. Hematologic parameters and angiographic progression of coronary atherosclerosis. Angiology. 2012;63:213-7.

Tanınd A, Erkan AF, Ekici B, Alhan A, Töre HF. Neutrophil to lymphocyte ratio is associated with more extensive, severe and complex coronary artery disease and impaired myocardial perfusion Arch Turk Soc Cardiol. 2014;42:125-30.

Duygui H, Zoghi M, Nalbantgil S, Ozerkan F, Cakir C, Ertas F, et al. High-sensitivity C-reactive protein may be an indicator of the development of atherosclerosis in myocardial bridging. Int J Cardiol. 2008;124:267-70.

Yildız A, Akil MA, Kayan F, Yüksel M, Bilik MZ, Oylumlu M, et al. Assessment of neutrophil / lymphocyte ratio in patients with myocardial bridge. J Clin Exper Inv. 2014;5:24-8.




How to Cite

Aksu, E., Avci, D., & Cikim, G. (2016). The relationship between neutrophil to lymphocyte ratio and myocardial bridge. International Journal of Research in Medical Sciences, 4(10), 4530–4534.



Original Research Articles