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Carrara A, Peluso L, Baccanelli F, Parrinello M, Santarpino G, Giroletti L, Graniero A, Agnino A, Albano G. Relationship between Preoperative Red Cell Distribution Width and Prolonged Postoperative Use of Catecholamines in Minimally Invasive Mitral Valve Surgery Patients: A Retrospective Cohort Study. J Clin Med 2024; 13:5736. [PMID: 39407797 PMCID: PMC11476661 DOI: 10.3390/jcm13195736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2024] [Revised: 09/17/2024] [Accepted: 09/25/2024] [Indexed: 10/20/2024] Open
Abstract
Background/Objectives: Elevated RDW has emerged in cardiac surgery as a potential means of preoperative risk stratification with the capacity to predict short- and long-term postoperative mortality, acute kidney injury, and postoperative atrial fibrillation. The question as to whether perioperative hemodynamic instability may be predicted by such a marker remains a topic of ongoing debate. The aim of this study was to explore the relationship between preoperative RDW and prolonged postoperative catecholamine use in minimally invasive mitral valve surgery. Methods: We performed a retrospective monocentric cohort study in an academic hospital; we enrolled patients who had undergone minimally invasive mitral valve surgery (including both robot-assisted and non-robot-assisted procedures) between January 2019 and December 2022. We considered the use of inotropes and/or vasopressors for at least twelve hours after post-surgery ICU admission to qualify as the prolonged postoperative use of catecholamines (PPUC). The RDW was obtained from the routine full blood count analysis performed upon admission or a maximum of 72 h before surgery. We also performed a multivariable logistic regression analysis with PPUC as the dependent variable. Results: We finally enrolled 343 patients. Upon multivariate analysis, RDW >14.4% was independently associated with prolonged postoperative catecholamine use when compared to the reference group (OR 2.62 [1.06-4.84]; p = 0.03). Moreover, the EuroSCORE II score (OR 1.38 [1.03-1.85]; p = 0.03), the cross-clamp time (OR 1.01 [1.01-1.02]; p < 0.01), and robot-assisted mitral valve surgery (OR 0.53 [0.30-0.93]; p < 0.03) were independently associated with the prolonged postoperative use of catecholamines. Conclusions: This study identified that an elevated preoperative RDW (>14.4%), the EuroSCORE II score, and the cross-clamp time independently predict prolonged postoperative catecholamine use in minimally invasive mitral valve surgery patients. Conversely, the robot-assisted approach was associated with a smaller hemodynamic impairment.
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Affiliation(s)
- Alfonso Carrara
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy (L.P.); (M.P.); (G.A.)
| | - Lorenzo Peluso
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy (L.P.); (M.P.); (G.A.)
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini, 4, Pieve Emanuele, 20072 Milan, Italy
| | - Federica Baccanelli
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy (L.P.); (M.P.); (G.A.)
| | - Matteo Parrinello
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy (L.P.); (M.P.); (G.A.)
| | - Giuseppe Santarpino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Viale Europa, 88100 Catanzaro, Italy
- Department of Cardiac Surgery, Paracelsus Medical University, 90419 Nuremberg, Germany
| | - Laura Giroletti
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy; (L.G.); (A.G.); (A.A.)
| | - Ascanio Graniero
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy; (L.G.); (A.G.); (A.A.)
| | - Alfonso Agnino
- Department of Cardiac Surgery, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy; (L.G.); (A.G.); (A.A.)
| | - Giovanni Albano
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni, Via M. Gavazzeni, 21, 24125 Bergamo, Italy (L.P.); (M.P.); (G.A.)
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Tadesse S, Tegene E, Yilma D, Yemane T, Gudina EK, Mossie A. Predictive role of hematological indices in patients with acute coronary syndrome in Ethiopia: Intrahospital outcomes. Heliyon 2024; 10:e36790. [PMID: 39281553 PMCID: PMC11401069 DOI: 10.1016/j.heliyon.2024.e36790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/20/2024] [Accepted: 08/22/2024] [Indexed: 09/18/2024] Open
Abstract
Background Apart from troponins, various additional biomarkers that indicate myocardial injury, inflammation, thrombosis, and other routes are being studied to improve the treatment of acute coronary syndrome (ACS). Myeloid activity has been found to be elevated in ACS, and this has sparked a great deal of interest in hematological parameters since they might offer independent insights into pathophysiology and risk assessment. Objective The purpose of this study was to evaluate the hematological markers' prognostic ability for all intrahospital causes of mortality in individuals with an ACS diagnosis. Methods A long-term cohort study based at an institution was done. At Jimma Medical Center, patients with an ACS diagnosis were progressively brought in between May 1, 2022, and October 31, 2023. Complete blood counts (CBC) and biochemical analysis were carried out. Multilevel mixed effect logistic regression was computed to evaluate the predictive competence of hematological indices on intrahospital mortality. Prognostic performance of hematological parameters was done using the ROC curve analysis. Result A total of 110 patients were included, of which 99 (90 %) were diagnosed ST-elevation myocardial infarction, and 74 (67.3 %) were men. The mean age was 56 (±11) years. RDW, platelet count, and MCV were independently associated with intrahospital mortality (AOR = 1.20 with P < 0.001, AOR = 0.995 with P < 0.03, and AOR = 0.897 with P < 0.025, respectively). The predictive power of RDW-SD for intrahospital mortality was evaluated by ROC analysis, the AUC value were 0.737 (95 % CI 0.669-0.805). Conclusion This study found that red cell distribution width, mean corpuscular volume, and platelets were predictive factors for intrahospital death in patients with ACS. Thus, it is possible to predict the prognosis of an ACS patient using hematological data.
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Affiliation(s)
- Samuel Tadesse
- Department of Biomedical Sciences, Jimma University, Ethiopia
| | - Elsah Tegene
- Department of Internal Medicine, Jimma University, Ethiopia
| | - Daniel Yilma
- Department of Internal Medicine, Jimma University, Ethiopia
| | - Tilahun Yemane
- Department of Medical Laboratory, Jimma University, Ethiopia
| | | | - Andualem Mossie
- Department of Biomedical Sciences, Jimma University, Ethiopia
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Li Z, Kang S, Kang H. Development and validation of nomograms for predicting cardiovascular disease risk in patients with prediabetes and diabetes. Sci Rep 2024; 14:20909. [PMID: 39245747 PMCID: PMC11381537 DOI: 10.1038/s41598-024-71904-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 09/02/2024] [Indexed: 09/10/2024] Open
Abstract
This study aimed to develop and validate distinct nomogram models for assessing CVD risk in individuals with prediabetes and diabetes. In a cross-sectional study design, we examined data from 2294 prediabetes and 1037 diabetics who participated in the National Health and Nutrition Examination Survey, which was conducted in the United States of America between 2007 and 2018. The dataset was randomly divided into training and validation cohorts at a ratio of 0.75-0.25. The Boruta feature selection method was used in the training cohort to identify optimal predictors for CVD diagnosis. A web-based dynamic nomogram was developed using the selected features, which were validated in the validation cohort. The Hosmer-Lemeshow test was performed to assess the nomogram's stability and performance. Receiver operating characteristics and calibration curves were used to assess the effectiveness of the nomogram. The clinical applicability of the nomogram was evaluated using decision curve analysis and clinical impact curves. In the prediabetes cohort, the CVD risk prediction nomogram included nine risk factors: age, smoking status, platelet/lymphocyte ratio, platelet count, white blood cell count, red cell distribution width, lactate dehydrogenase level, sleep disorder, and hypertension. In the diabetes cohort, the CVD risk prediction nomogram included eleven risk factors: age, material status, smoking status, systemic inflammatory response index, neutrophil-to-lymphocyte ratio, red cell distribution width, lactate dehydrogenase, high-density lipoprotein cholesterol, sleep disorder, hypertension, and physical activity. The nomogram models developed in this study have good predictive and discriminant utility for predicting CVD risk in patients with prediabetes and diabetes.
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Affiliation(s)
- Zhao Li
- College of Sport Science, Sungkyunkwan University, 2066 Seoburo, 16419, Jangan-gu, Suwon, Republic of Korea
| | - Seamon Kang
- College of Sport Science, Sungkyunkwan University, 2066 Seoburo, 16419, Jangan-gu, Suwon, Republic of Korea
| | - Hyunsik Kang
- College of Sport Science, Sungkyunkwan University, 2066 Seoburo, 16419, Jangan-gu, Suwon, Republic of Korea.
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Segura-Saldaña PA, Chambergo-Michilot D, Alarcón-Santos JE, Aguilar C, Alvarez-Vargas ML, Padilla-Reyes M, Leon-Vivar R, Pariona-Javier M. Evaluating three biomarkers as prognostic factors of in-hospital mortality and severity in heart failure: A prospective cohort. Rev Port Cardiol 2022; 41:31-40. [DOI: 10.1016/j.repc.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 01/21/2021] [Accepted: 03/05/2021] [Indexed: 11/28/2022] Open
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Red cell distribution width levels in Parkinson's disease patients. Acta Neurol Belg 2020; 120:1147-1150. [PMID: 31367945 DOI: 10.1007/s13760-019-01197-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 07/23/2019] [Indexed: 12/28/2022]
Abstract
Parkinson's disease (PD) is a neurodegenerative disorder with motor and non-motor impairment. It has been known for a while that oxidative stress, protein changes and mitochondrial dysfunction have the role of contribution to the pathogenesis. Disturbance of red blood cell function may play a role in the pathophysiology of neurodegenerative diseases such as Huntington's, Parkinson's and Alzheimer's disease. RDW was found to be strongly associated with inflammatory markers in diseases such as acute pancreatitis, myocardial injury and hepatocellular carcinoma. The data about RDW levels and PD are scarce. In this study, we aimed to investigate the RDW values and their relationship with the severity of the disease in patients with Parkinson's disease. 94 patients with Parkinson's disease were included into the study, 97 healthy individuals without history of PD were considered as control group. The United Parkinson's Disease Rating Scale (UPDRS) and the modified Hoehn and Yahr staging scale were used to assess the severity of PD. Although RDW levels were significantly higher than the healthy subjects, there was not any relation between the severity of PD, duration of the disease, RDW levels, other blood parameters, mean UPDRS score or mean mH&Y score. In conclusion, RDW levels are higher than the healthy subjects in PD patients but there is no relation between RDW levels and disease duration. Larger studies are needed to explain the role of RDW as an inflammatory marker.
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Coşkun A, Eren SH. R/S ratio in lead II, and the prognostic significance of red cell distribution width in acute coronary syndrome. World J Clin Cases 2019; 7:2217-2226. [PMID: 31531316 PMCID: PMC6718784 DOI: 10.12998/wjcc.v7.i16.2217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/26/2015] [Accepted: 07/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND In spite of developing medical technologies to discover the etiopathogenesis of diseases and developments in the treatment of coronary artery disease, acute coronary syndromes (ACS) continue to be the main cause of mortality and morbidity worldwide. New cardiac biomarkers and techniques are needed to help provide rapid diagnosis in order to evaluate risk in coronary artery patients. AIM To evaluate the effects of R to S ratio (RSR) in the electrocardiograph of patients with ACS, from the point of the arising complication after myocardial infarction (MI), to three-vessel disease (TVD) and mortality. METHODS The data of 1,296 patients with ACS, who presented to the emergency department of our hospital with chest pain between January 2014 and December 2018 and were admitted to the cardiology clinic, were retrospectively included in this cross-sectional cohort study. Patients with an RSR value less than I were assigned to group I, while those with an RSR value greater than I were assigned to group II. RESULTS In our study, 466 (35.9%) of the 1,296 patients, 357 (38.3%) in group 1 and 109 (29.9%) in group 2, were female, with a mean age of 61.56 ± 9.42. ST-elevation MI 573 (44.2%), unstable angina (UA) 502 (38.7%) and non ST-elevation MI 220 (17%) were more prevalent in group I. Acute anterior MI 263 (20.3) in group I, and acute inferior MI 184 (14.2) in group II was higher. Ischemic heart failure was the most common complication. In group II, the red cell distribution width (RDW) was 15.42 ± 1.82, the gensini score was 48.39 ± 36.44, the left ventricular ejection fraction was 41.17 ± 10.41, the TVD was 111 (8.5), and the mortality rate was 72 (5.6), which was significantly higher than group I RDW; in MI with ST and non-ST-elevation, in TVD, mortality and complications were high and low in UA. In single and multivariate regression analyses, the variables were associated with ACS risk. CONCLUSION RSR levels may be an auxiliary predictive value in ACS in terms of complications developing after MI, TVD, and mortality.
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Affiliation(s)
- Abuzer Coşkun
- Department of Emergency, Sivas Numune Hospital, Sivas 58040, Turkey
| | - Sevki Hakan Eren
- Department of Emergency Medicine, Gaziantep University School of Medicine, Gaziantep 27310, Turkey
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Dai L, Mick SL, McCrae KR, Houghtaling PL, Blackstone EH, Koch CG. Prognostic Value of Preoperative Red Cell Distribution Width: Fine-Tuning by Mean Corpuscular Volume. Ann Thorac Surg 2019; 108:1830-1838. [PMID: 31199898 DOI: 10.1016/j.athoracsur.2019.04.072] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 03/19/2019] [Accepted: 04/22/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Abnormal red cell distribution width (RDW), reflecting heterogeneity of red blood cell (RBC) size, is associated with cardiovascular disease outcomes. However, whether RBC size itself, expressed as mean corpuscular volume (MCV), provides additional prognostic value is unclear. We therefore investigated the relationship between outcomes after cardiac surgery and both RDW and MCV simultaneously. METHODS From January 2010 to January 2014, 16,097 patients underwent cardiac surgery at Cleveland Clinic and had complete blood count findings available for analysis. Outcomes included RBC transfusion, postoperative complications, and intensive care unit (ICU) and postoperative hospital lengths of stay. Risk-adjusted associations of RDW and MCV with outcomes and their relative importance in predicting outcome were identified by random forest machine learning. RESULTS High RDW was associated with more RBC transfusions. Except for postoperative atrial fibrillation, risks of complications and ICU and postoperative lengths of stay were at their minimum when RDW was normal, 13% to 14%. The relationship of MCV to complications was U-shaped: high (macrocytosis) and low (microcytosis) values were associated with higher risk. RDW was an important risk factor for most postoperative outcomes and lengths of stay; MCV was less so, but provided prognostic value in addition to RDW alone, particularly when there was macrocytosis. CONCLUSIONS Abnormal RDW and MCV are associated with higher risk of transfusion and postoperative outcomes after cardiac surgery. RDW is one of the most important variables in predicting outcomes, but MCV provides additional prognostic value. Both should be taken into consideration when estimating the perioperative risk of patients undergoing cardiac surgery.
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Affiliation(s)
- Lu Dai
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Stephanie L Mick
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Keith R McCrae
- Department of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
| | - Penny L Houghtaling
- Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio
| | - Eugene H Blackstone
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Colleen G Koch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland
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Red Cell Distribution Width as a Novel Marker for Different Types of Atrial Fibrillation in Low and High Altitude. Cardiol Res Pract 2019; 2019:6291964. [PMID: 30984423 PMCID: PMC6431478 DOI: 10.1155/2019/6291964] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/28/2019] [Indexed: 12/16/2022] Open
Abstract
Background Increased red cell distribution width (RDW) can predict the incidence and mortality of cardiovascular diseases. However, there are limited data on the relationship between RDW and altitude and the subtype of atrial fibrillation (AF). We investigated the effects of altitude on RDW in patients with different types of AF. Methods A total of 303 patients with nonvalvular AF were included. Of these, 156 lived in low altitude (77 paroxysmal AF, PAF; 79 persistent AF, PeAF) and 147 in high altitude (77 paroxysmal AF, PAF; 70 persistent AF, PeAF). In these groups, baseline characteristics, complete blood counts, serum biochemistry, and echocardiography were evaluated. Multivariate logistic regression analysis was conducted to determine the independent predictors of AF at the different altitudes. Results In both low and high altitudes, RDW and left atrial diameter (LAD) were higher in AF than control subjects (P < 0.05) and higher in persistent AF than paroxysmal AF (P < 0.05). Compared with any groups (PAF group, PeAF group, or control group) of low-altitude, RDW and LAD were found higher in high-altitude corresponding groups. Multivariate logistic regression analysis demonstrated that RDW, mean corpuscular volume (MCV), and LAD levels independently associated with AF patients in low altitude (RDW, OR 1.687, 95% CI 1.021–2.789; P < 0.05), while in high altitude, RDW, MCV, creatinine (Cr), and LAD were independent predictors for AF patients (RDW, OR 1.755, 95% CI 1.179–2.613; P < 0.05). Conclusion Elevated RDW levels may be an independent risk marker for nonvalvular AF, affected by type of AF and altitude.
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Ćatić J, Jurin I, Lucijanić M, Jerkić H, Blažeković R. High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting diastolic than systolic left ventricular dysfunction: A single-center prospective cohort study. Medicine (Baltimore) 2018; 97:e0601. [PMID: 29718862 PMCID: PMC6393031 DOI: 10.1097/md.0000000000010601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Multiple studies have demonstrated the association of red cell distribution width (RDW) with the ultrasound parameters of both systolic and diastolic heart dysfunction. We aimed to further investigate the clinical associations of RDW in the setting of ST-elevation myocardial infarction (STEMI) and to comparatively evaluate its predictive properties regarding systolic and diastolic dysfunction.A total of 89 patients with STEMI were prospectively analyzed. RDW was obtained at the time of STEMI and compared to the parameters of systolic and diastolic dysfunction obtained by transthoracic heart ultrasound on the 5th through 7th day post-STEMI.The median RDW was 13.9%, and among other factors, RDW was significantly associated with older age (P < .001), arterial hypertension (P = .017), hyperlipoproteinemia 2, nonsmoking (P = .027), increased thrombolysis in myocardial infarction score (P = .004), and multivessel disease (P = .007). A higher RDW was observed in patients with parameters that indicated systolic and diastolic dysfunction (ejection fraction of the left ventricle < 50% [P = .009], early/late diastolic filling wave ratio [E/A] < 1 [P = .001], ratio of peak early transmitral velocity and early diastolic annular velocity [E/E'] >10 [P < .001], and combined E/A < 1 and E/E' > 10 [P < .001]). The best discriminatory properties were observed for combined E/A < 1 and E/E' > 10. RDW remained significantly associated with the aforementioned parameters in a series of multivariate regression models.Elevated RDW is significantly associated with the parameters of systolic and diastolic dysfunction even after adjusting for several confounding factors in the setting of STEMI and subsequent percutaneous coronary intervention. RDW seems to be better at discriminating patients with diastolic rather than systolic dysfunction.
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Affiliation(s)
- Jasmina Ćatić
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
| | - Ivana Jurin
- Department of Cardiology, Clinical Hospital “Dubrava”, Zagreb
| | | | - Helena Jerkić
- Department of Cardiology, Clinical Hospital “Merkur”
| | - Robert Blažeković
- Faculty of Medicine, “J.J. Strossmayer” University of Osijek, Osijek
- Department of Cardiac and Transplant Surgery, Clinical Hospital “Dubrava”, Zagreb, Croatia
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Contreras Gutiérrez V. Red cell distribution width: A marker of in-hospital mortality in ST-segment elevation myocardial infarction patients? REVISTA MÉDICA DEL HOSPITAL GENERAL DE MÉXICO 2017. [DOI: 10.1016/j.hgmx.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nagula P, Karumuri S, Otikunta AN, Yerrabandi SRV. "Correlation of red blood cell distribution width with the severity of coronary artery disease-A single center study". Indian Heart J 2017; 69:757-761. [PMID: 29174254 PMCID: PMC5717282 DOI: 10.1016/j.ihj.2017.04.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/22/2017] [Accepted: 04/11/2017] [Indexed: 02/02/2023] Open
Abstract
Objective Coronary Artery Disease (CAD) is the leading cause of morbidity and mortality all around the world. We evaluated the correlation of Red blood cell Distribution Width (RDW) with the severity of lesion on coronary angiography as assessed by Modified Gensini score (MGS) in CAD patients. Methods A total of 576 consecutive patients admitted in Department of Cardiology over a period of one year, who underwent coronary angiography after diagnosis of CAD or presence of angina like chest pain and/or positive treadmill test were enrolled in the study (August 2014–May 2015). Patients were divided into two groups, with CAD (Group A) and without CAD (Group B). The RDW Cofficience of variance (RDW CV) and RDW standard deviatiton (RDW SD) of each patient, and their correlation with severity of CAD was assessed. Results Of the total 576 patients enrolled, 438 were in Group A and 138 were in Group B. The mean age of presentation in Group A and Group B was (53.64 ± 10.36 vs 49.4 ± 9.73) years (p < 0.0001). The Male and Female ratio overall was 2.42:1. Patients in Group A had significantly elevated RDW CV and RDW SD levels compared with those in Group B [(14.59 ± 1.04)% vs (13.6 ± 0.68)%, p < 0.0001], [(45.78 ± 4.76) vs (40.77 ± 3.01), p < 0.0001 respectively]. A significant positive correlation between RDW CV, RDW SD and MGS was noted (r = 0.33, p < 0.0001) (r = 0.43, p < 0.0001) respectively. On multivariate logistic regression analysis, RDW was demonstrated to be an independent predictor for angiographic CAD (OR = 4.17, 95% CI 3.05–5.69, p < 0.0001). On receiver operating characteristic curve (ROC) analysis, an RDW value of 14.3% was identified as an effective cut off point in diagnosing CAD with a sensitivity of 58.9% and specificity of 84.8%. Conclusions RDW is an independent predictor of CAD and severity of coronary stenosis, suggesting that it can be a readily available marker for prediction and severity of CAD.
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Affiliation(s)
- Praveen Nagula
- Department of Cardiology, Osmania General Hospital, Afzalgunj, Hyderabad, Telangana 500012, India.
| | - Suneetha Karumuri
- Department of Cardiology, Osmania General Hospital, Afzalgunj, Hyderabad, Telangana 500012, India.
| | - Adikesava Naidu Otikunta
- Department of Cardiology, Osmania General Hospital, Afzalgunj, Hyderabad, Telangana 500012, India.
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Alhusseiny AH, Al-Nimer MSM, Mohammad FI, Ali Jadoo SA. Concomitant measurements of serum annexin A5 levels and hematological indices as markers in recent and old myocardial infarction with low ejection fraction: A preliminary study. Int J Cardiol 2016; 223:514-518. [PMID: 27552568 DOI: 10.1016/j.ijcard.2016.08.244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/10/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Serum annexin A5 (anxA5) level is significantly increased in patients with acute coronary syndrome. Hematological indices are significantly increased in patients with ischemic heart disease. This study aimed to demonstrate the changes in the distribution of blood cells and the levels of anxA5 in patients presented with significant low ejection fraction ST-elevation acute myocardial infarction (STEMI) in comparison with corresponding patients with ischemic heart disease. METHODS Patients with low ejection fraction presenting at Hospital of Diyala University of Iraq were enrolled. Electrocardiograph (ECG), echocardiograph, hematological indices, serum annexin V (anxV) levels and the determinants of the cardio-metabolic risk factors were performed. Based on clinical examination, ECG findings and laboratory tests, patients were divided into healthy subjects (n=20); patients with acute MI (n=40) and with chronic MI (n=12). RESULTS Acute MI has significant high levels of serum triglyceride, uric acid and high mean value of red cell distribution width (RDW) compared with healthy subjects and chronic MI. Platelet distribution width (PDW) is significantly reduced in patients of acute MI and chronic MI compared with healthy subjects, whereas the plateletcrit (PCT) is significantly higher in acute MI compared with healthy subjects. There is an insignificant difference between the means of serum anxA5 levels of acute MI (35.6±7.2ng/ml) and chronic MI (32.4±8.9ng/ml), but significantly higher than the cutoff level of the healthy subjects (5ng/ml). CONCLUSIONS Measurement of serum annexin level is a useful diagnostic marker of acute or chronic MI with low ejection fraction.
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Affiliation(s)
| | - Marwan S M Al-Nimer
- Department of Pharmacology, College of Medicine, Al-Mustansiriya University, Baghdad, Iraq
| | | | - Saad Ahmed Ali Jadoo
- International Centre for Casemix and Clinical coding, National University of Malaysia Kuala Lumpur, Malaysia.
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Ghaffari S, Pourafkari L, Sepehrvand N, Aslanabadi N, Faridi L, Tajlil A, Masoumi N, Nader ND. Red cell distribution width is a predictor of ST resolution and clinical outcome following thrombolysis in acute ST elevation myocardial infarction. Thromb Res 2016; 140:1-6. [PMID: 26896606 DOI: 10.1016/j.thromres.2016.02.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/01/2016] [Accepted: 02/07/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Red cell distribution width (RDW) has been shown to associate with adverse outcomes in various cardiovascular diseases. We aimed to explore the predictive value of RDW for resolution of the ST segment (STR) after thrombolytic therapy in patients with ST elevation myocardial infarction (STEMI). METHODS Patients with STEMI with indication for thrombolytic therapy were recruited from a university center between 2013 and 2015. A comprehensive laboratory investigation at the time of admission included measurement of RDW. Following thrombolysis ST segment resolution was assessed after 90 min. A positive response (STR ≥ 50%) was the primary endpoint. Secondary endpoints were major adverse cardiac events (MACE) defined as occurrence of acute heart failure, ventricular dysrhythmia beyond the first 24h, cardiac arrest or death during hospitalization. RESULTS A total of 312 patients (271 male) with the mean age of 57.9 ± 12.3 were enrolled. RDW on admission was 14.1 ± 1.0% (range: 11.6-17.7%). STR was seen in 191 cases (61.2%). MACE occurred in 36 (11.5%) patients. The long-term mortality rate was 7.1% during the follow-up period of 7.7 ± 3.2 months. Even after adjusting for co-morbid conditions, in multivariate model, baseline RDW, independently predicts STR (RR=2.46, 95% CI 1.32-4.57, P=0.005) and in hospital occurrence of MACE (RR=3.17, 95% CI 1.23-8.46, p=0.017). The cut-off values for RDW in predicting STR and MACE were 14.2% and 14.4%, respectively. CONCLUSION An elevated baseline RDW could predict adverse outcomes and response to thrombolytic therapy in patients with STEMI. This extends our knowledge about RDW value in prognostication.
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Affiliation(s)
- Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leili Pourafkari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Anesthesiology, University at Buffalo, Buffalo, NY, United States.
| | | | - Naser Aslanabadi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Leili Faridi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Arezou Tajlil
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Nayyer Masoumi
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, Buffalo, NY, United States.
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Danese E, Lippi G, Montagnana M. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis 2015; 7:E402-11. [PMID: 26623117 DOI: 10.3978/j.issn.2072-1439.2015.10.04] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The red blood cell distribution width (RDW) is a rather simple measure of red blood cell (RBC) size heterogeneity (i.e., anisocytosis), which is easily calculated by dividing the standard deviation (SD) of erythrocyte volumes for the mean corpuscular volume (MCV). Emerging evidence suggests that, besides RBC abnormalities, many human disorders may be frequently associated with a high degree of anisocytosis. METHODS In this narrative review, we analyzed the current scientific literature about the putative role and the potential epidemiologic association between RDW and cardiovascular diseases. The findings of the most representative epidemiological studies were summarized and discussed. RESULTS Overall, considerable and convincing evidence has been brought that an increased RDW value is associated with acute coronary syndrome (ACS) [including acute myocardial infarction (AMI)], ischemic cerebrovascular disease (including stroke), peripheral artery disease (PAD), as well as with atrial fibrillation (AF), heart failure (HF) and hypertension. Higher anisocytosis also significantly and independently predicts adverse outcomes in patients with these conditions. CONCLUSIONS Although the role of anisocytosis in the pathogenesis of cardiovascular diseases remains uncertain, the considerable evidence available so far suggests that the clinical use of RDW may be broadened beyond the conventional boundaries of erythrocyte disorders, in particular for assisting the diagnosis and prognostication of patients with ACS, ischemic cerebrovascular disease, PAD, HF and AF.
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Affiliation(s)
- Elisa Danese
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Giuseppe Lippi
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
| | - Martina Montagnana
- Clinical Biochemistry Section, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona, Italy
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