Systemic immune-inflammation index predicts 2-year major adverse cardiovascular events in patients with hypertrophic cardiomyopathy
C Tunca, B Cuvalcioglu, B Ozlek, V O TanikAbstract
Background
Hypertrophic cardiomyopathy (HCM) is a genetically determined myocardial disease associated with heterogeneous clinical outcomes, ranging from long-term stability to sudden cardiac death and progressive heart failure. Systemic inflammation has emerged as an important contributor to adverse cardiovascular remodeling and arrhythmic risk; however, simple inflammatory markers for early risk stratification in HCM remain limited. The systemic immune-inflammation index (SII), calculated fromroutine hematological parameters, reflects the balance between inflammatory activation and immune regulation and may provide incremental prognostic information in this population.
Purpose
To investigate the prognostic value of admission systemic immune-inflammation index (SII) for predicting 2-year major adverse cardiovascular events (MACE) in patients with hypertrophic cardiomyopathy.
Methods
This retrospective single-center study included 276 consecutive patients diagnosed with HCM between 2019 and 2024. SII was calculated at baseline using the formula platelet count × neutrophil count / lymphocyte count. Patients were dichotomized into low and high SII groups according to the median SII value. The primary endpoint was 2-year composite MACE, defined as all-cause mortality, heart failure hospitalization, sustained ventricular tachyarrhythmia or appropriate implantable cardioverter-defibrillator shock, and ischemic stroke. Event-free survival was assessed using Kaplan–Meier analysis, and independent predictors of MACE were identified using Cox proportional hazards regression.
Results
The mean age of the study population was 56 ± 14 years, and 64% were male. During a 2-year follow-up period, composite MACE occurred in approximately one-quarter of patients. Patients in the high SII group experienced a significantly higher incidence of MACE compared with those in the low SII group. Kaplan–Meier analysis demonstrated significantly reduced MACE-free survival in patients with elevated SII (log-rank p<0.01). In multivariable Cox regression analysis adjusted for age, atrial fibrillation, left ventricular ejection fraction, and left ventricular outflow tract gradient, high SII remained an independent predictor of 2-year MACE.
Conclusion
Admission systemic immune-inflammation index is a simple, inexpensive, and readily available biomarker that independently predicts 2-year major adverse cardiovascular events in patients with hypertrophic cardiomyopathy. Incorporation of SII into routine clinical assessment may improve early risk stratification in this heterogeneous patient population.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.