Relationship between Systemic Immune-Inflammatory Index (SII) and the burden of premature ventricular complex in 24-hour holter recording

Objectives: Premature ventricular complex is a rhythm disorder associated with increased cardiovascular mortality and morbidity that is frequently encountered in Holter and 12-lead electrocardiography recordings in the adult age group. While patients with premature ventricular complex may be completely asymptomatic, some patients may develop premature ventricular complex induced cardiomyopathy. The most important risk factor in the development of premature ventricular complex induced cardiomyopathy is premature ventricular complex load. Holter monitoring is a useful method in the clinic to detect arrhythmia, evaluate its frequency, duration and symptoms. Holter monitoring is performed for risk assessment and treatment monitoring in patients with premature ventricular complex. Previous studies have shown that there is a relationship between premature ventricular complex frequency and inflammation. Systemic immune inflammatory index is a systemic inflammatory response marker calculated as a result of complete blood count (neutrophil x platelet / lymphocyte), which has been researched more in recent years and has been shown to be associated with diseases such as various malignancies, coronary artery disease and hypertension. The aim of our study is to investigate the relationship between systemic immune inflammatory index and premature ventricular complex burden in patients evaluated with a preliminary diagnosis of arrhythmia and 24-hour Holter monitoring at the Gaziosmanpaşa University Faculty of Medicine Department of Cardiology outpatient clinic. Methods: In our study, 195 patients who were diagnosed with arrhythmia and planned to undergo 24-hour Holter monitoring at the Cardiology Department of Tokat Gaziosmanpaşa University Faculty of Medicine Hospital between January 1, 2022 and January 1, 2023, were included according to the inclusion and exclusion criteria. The anamnesis, physical examination findings and demographic information of the patients included in the study were completely recorded in the hospital system. Patients who had no previous chronic disease, no history of chronic drug use, no signs of active infection, and no history of moderate or severe Covid-19 pneumonia were included in our study. Patients were monitored 24 hours a day with devices capable of recording holter on 3 channels available in our center. Patients with premature ventricular complex below 1,000 bpm in 24-hour monitoring were grouped as group 1, patients with 1,000-10,000 bpm/day were grouped as group 2, and patients with 10,000 or more bpm/day were grouped as group 3. The patients' complete blood count results were obtained through our hospital's data storage system. Systemic immune inflammatory index as suggested in other studies; It was calculated as: the number of neutrophils ୶ the number of platelets the number of lymphocytes . It was considered statistically significant if P values were less than 0.05. Results: Among the patient groups, systemic immune inflammatory index was found to be higher in group 3 than in groups 1 and group 2, and this difference was found to be statistically significant (P: <0.001). A statistically significant difference was found between group 1 and group 2 in terms of systemic immune inflammatory index. In our study, a weak correlation was detected between the daily premature ventricular complex count and systemic immune inflammatory index in binary correlations made without grouping (r:0.327, P<0.001). Again, in binary correlations, premature ventricular complex number and age (r:0.219, v P:0.002), left atrium diameter (r:0.218, P:0.002), aortic diameter (r:0.210, P:0.003) and pulmonary artery systolic pressure (r:0.221, P:0.002) a weak positive correlation was detected. A negative correlation was detected between left ventricular ejection fraction and premature ventricular complex (r:-0.362, P<0.001). In the bilateral correlation of biochemical parameters with Holter findings, no significant correlation was detected between premature ventricular complex count and C-reactive protein (r:0,044, P:0,545), thyroid stimulating hormone (r:- 0,188, P:0,008) and soluble thyroxine 4 (r:-0,022, P:0,757) levels. Conclusion: Our study is the first to examine the relationship between the systemic immune inflammatory index, an indicator of subclinical inflammation, and the number of premature ventricular complex. According to our findings, systemic immune inflammatory index is higher in patient groups with premature ventricular complex count of 10,000 beats and above, and this height is statistically significant. We detected a weak correlation between the daily number of premature ventricular complex and the systemic immune inflammatory index, and we showed that the reason for this was that the correlation between the number of premature ventricular complex and systemic immune inflammatory index occurred at high premature ventricular complex counts (10,000 beats per day and above). We found that neutrophil lymphocyte ratio and platelet lymphocyte ratio were also correlated with premature ventricular complex load, as found in previous studies. In conclusion, in our study, we showed that there is a relationship between systemic immune inflammatory index and premature ventricular complex frequency and that this relationship occurs at high premature ventricular complex loads. We found that systemic immune inflammatory index is a predictor of premature ventricular complex frequency. Systemic immune inflammatory index value may be a parameter that can be used in diagnosis and follow-up in patients with high premature ventricular complex burden. Keywords: Systemic Immune Inflammatory Index, Premature Ventricular Complex, Holter, Inflammation