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Predictive value of the monocyte-to-high-density lipoprotein cholesterol ratio in atrial fibrillation: a
Xiangzhu Meng1, Yuhang Wen1, Xiangying Wang2
1Department of Cardiology, Institute of Cardiovascular Diseases, The First Affiliated Hospital of Dalian Medical University, Dalian, China.
Insights
The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) shows moderate accuracy in predicting atrial fibrillation (AF) risk. It is best used as a complementary biomarker, with performance varying by AF type.
Area of Science:
- Cardiology
- Biomarkers
- Atrial Fibrillation Research
Background:
- The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) is a novel cardiovascular biomarker.
- Its predictive value for atrial fibrillation (AF) risk requires further investigation.
Purpose of the Study:
- To evaluate the diagnostic accuracy of MHR in predicting AF risk.
- To explore the association between MHR and AF development.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science.
- Meta-analysis using summary receiver operating characteristic (SROC) curve analysis.
- Calculation of pooled odds ratio (OR), sensitivity, specificity, and area under the curve (AUC).
Main Results:
- 13 studies with 5,499 participants showed elevated MHR associated with increased AF risk (OR=1.21).
- Pooled sensitivity was 0.85, specificity 0.68, and AUC 0.80.
- MHR performance varied by AF phenotype, with highest accuracy in non-procedural AF (AUC=0.94).
Conclusions:
- MHR demonstrates moderate diagnostic accuracy for AF risk, suitable as a screening or complementary tool.
- Diagnostic performance is influenced by AF phenotype and clinical context.
- Large-scale prospective studies are needed to validate findings and standardize MHR cut-offs.
Background:
The monocyte-to-high-density lipoprotein cholesterol ratio (MHR) has emerged as a novel biomarker for cardiovascular outcomes. However, its role in atrial fibrillation (AF) remains unclear. This meta-analysis aimed to evaluate the diagnostic efficacy of MHR in predicting AF risk.
Methods:
We systematically searched PubMed, Embase, and Web of Science up to March 20, 2025. The primary outcome was to assess the diagnostic accuracy of MHR for predicting AF using summary receiver operating characteristic (SROC) curve analysis. The secondary outcome was to explore the relationship between MHR and AF risk. Pooled odds ratio (OR), sensitivity, specificity, and area under the curve (AUC) were calculated.
Results:
A total of 13 studies comprising 5,499 participants were included. Elevated MHR was independently associated with an increased AF risk (OR = 1.21; 95% CI, 1.11-1.31; P < 0.001). The pooled sensitivity and specificity were 0.85 (95% CI, 0.71-0.93) and 0.68 (95% CI, 0.60-0.75), yielding an area under the SROC curve of 0.80 (95% CI, 0.76-0.83). Subgroup analyses revealed significant diagnostic performance variations by AF phenotype: MHR had the highest sensitivity (0.91; 95% CI 0.74-1.00) and AUC (0.94; 95% CI 0.91-0.96) in non-procedural AF, followed by post-ablation recurrence (sensitivity = 0.86, AUC = 0.83) and new-onset AF (sensitivity = 0.80, AUC = 0.83). Large-sample studies (>600) showed lower sensitivity (0.71 vs. 0.90) but higher specificity (0.78 vs. 0.60) than small-sample studies (≤600). No significant publication bias was detected (p = 0.45).
Conclusions:
MHR demonstrates moderate diagnostic accuracy for AF risk prediction and is better suited as a screening or complementary biomarker than a standalone diagnostic tool. Its diagnostic performance varies significantly by AF phenotype and clinical context. Given the limited number of studies, significant heterogeneity, and unstandardized MHR cut-offs, large-scale prospective studies with standardized protocols are warranted to validate these findings and facilitate targeted clinical application.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/, identifier CRD420251030225.
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