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Johnson MM, Gicking JC, Keys DA. Evaluation of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and other hematologic parameters in canine acute pancreatitis. J Vet Emerg Crit Care (San Antonio) 2023; 33:587-597. [PMID: 37573255 DOI: 10.1111/vec.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/15/2022] [Accepted: 06/20/2022] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To determine if RBC distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and other hematological parameters are associated with increased odds of in-hospital mortality, increased length of hospitalization (LOH), or disease severity as measured by the Canine Acute Pancreatitis Severity (CAPS) score in dogs with acute pancreatitis (AP). DESIGN Retrospective, multicenter study from January 2016 to August 2020. SETTING Four private emergency and specialty referral centers. ANIMALS On initial case search, 118 client-owned dogs were identified with a clinical diagnosis of AP. Out of these cases, 114 dogs met inclusion criteria, defined as sudden onset of ≥2 compatible clinic signs (lethargy, anorexia, vomiting, or abdominal pain), a specific canine pancreatic lipase concentration >400 μg/L, hospital admission, as well as CBC and serum biochemistry run within 48 hours of initial hospitalization. Disease severity was calculated and measured using the CAPS score, in addition to LOH and in-hospital mortality. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical endpoints were in-hospital mortality, LOH, and disease severity, as evaluated by the CAPS score. Overall in-hospital mortality was 36.8%. NLR was significantly associated with survival, with a higher percentage being associated with an increased likelihood of nonsurvival (odds ratio: 1.1, 95% confidence interval: 1.0-1.2; P = 0.006, adjusted P = 0.04). Increased NLR was found to be significantly associated with a longer LOH based on the unadjusted P-value (P = 0.02) but was not statistically significant based on a P-value adjusted for multiple comparisons (P = 0.12). No significant associations were noted when RDW, platelet-to-lymphocyte ratio, WBC count, mean platelet volume, RDW-to-platelet ratio, or RDW-to-total serum calcium ratio was evaluated against outcome measures. CONCLUSIONS This study retrospectively evaluated the prognostic utility of several readily available hematological parameters in dogs hospitalized for AP. Dogs with an increased NLR may have a higher risk of in-hospital mortality and increased LOH, although future prospective studies are necessary to confirm these findings.
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Affiliation(s)
- Meghan M Johnson
- Emergency & Critical Care Service, BluePearl Specialty + Emergency Pet Hospital, Lafayette, Colorado, USA
| | - John C Gicking
- Emergency & Critical Care Service, BluePearl Specialty + Emergency Pet Hospital, Tampa, Florida, USA
| | - Deborah A Keys
- Kaleidoscope Statistics Veterinary Medical Research Consulting, Athens, Georgia, USA
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2
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Scalco R, de Oliveira GN, da Rosa Curcio B, Wooten M, Magdesian KG, Hidai ST, Pandit P, Aleman M. Red blood cell distribution width to platelet ratio in neonatal foals with sepsis. J Vet Intern Med 2023; 37:1552-1560. [PMID: 37306395 PMCID: PMC10365058 DOI: 10.1111/jvim.16793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Rapid and accurate markers to aid diagnosis of sepsis are needed in neonatal foals. The CBC variable red blood cell distribution width (RDW) to platelet ratio (RPR) is associated with inflammatory response and linked to poor outcomes of sepsis in human patients. HYPOTHESIS Explore the correlation of RPR with sepsis in neonatal foals and evaluate RPR predictive and prognostic value. ANIMALS Three hundred seventeen hospitalized neonatal foals ≤7 days of age that had a CBC and physical exam performed at admission between 2012 and 2021. METHODS Retrospective case-control study. Clinical records were used to calculate sepsis scores and define groups. Red blood cell distribution width to platelet ratio was calculated and compared between groups (septic vs nonseptic) based on Kruskal-Wallis and Wilcoxon signed-rank tests. A multivariate logistic regression model to predict sepsis was created. The cutoff for RPR was obtained based on the maximal Youden Index. The Kaplan-Meier method and the log-rank test were used to estimate survival curves and compare survival rates based on RPR. RESULTS Red blood cell distribution width to platelet ratio was significantly higher in septic foals (Median = 0.099, confidence interval [CI] [0.093; 0.108]) than in sick nonseptic (0.085, CI [0.083; 0.089]) and healthy foals (0.081, CI [0.077; 0.086]; P < .0001). Red blood cell distribution width to platelet ratio was able to predict sepsis with high accuracy (AUC = 82.1%). The optimal RPR cutoff for sepsis was 0.09. CONCLUSIONS AND CLINICAL IMPORTANCE Red blood cell distribution width to platelet ratio calculation is practical, inexpensive, and based on CBC-derived data. Calculation of RPR along with CBC can aid in the diagnosis of sepsis and estimation of outcome.
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Affiliation(s)
- Rebeca Scalco
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
- Present address:
Department of Pathology & Laboratory MedicineSchool of Medicine, University of CaliforniaSacramentoCaliforniaUSA
| | - Gabriela Novo de Oliveira
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Bruna da Rosa Curcio
- Department of Veterinary Clinics, School of Veterinary MedicineUniversidade Federal de Pelotas‐RSPelotasBrazil
| | - McCaide Wooten
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
- Present address:
Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Stephanie Takako Hidai
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Pranav Pandit
- EpiCenter for Disease Dynamics, One Health Institute, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Monica Aleman
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
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Miglio A, Valente C, Guglielmini C. Red Blood Cell Distribution Width as a Novel Parameter in Canine Disorders: Literature Review and Future Prospective. Animals (Basel) 2023; 13:ani13060985. [PMID: 36978525 PMCID: PMC10044289 DOI: 10.3390/ani13060985] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Red blood cell distribution width (RDW) is a quantitative laboratory parameter applied for the measurement of anisocytosis and is a reliable and inexpensive method for clinical classification of anemia. An increased RDW reflects a great heterogeneity in the size of red blood cells typical of regenerative and iron-deficiency anemia. In humans, numerous and recent studies have shown a relationship between increased RDW and the risk of morbidity and mortality in patients with various disorders. In particular, a strong association has been established between changes in RDW and the risk of adverse outcome in humans with diseases affecting different organs or systems. Following the human literature, some studies have recently been conducted trying to clarify the clinical role of RDW in various animal disorders, particularly in dogs. In this review, we summarize and critically evaluate the results of the studies based on the measurement of RDW in dogs. We also emphasize the need for further and more extensive studies on the use of this simple and inexpensive parameter in animals.
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Affiliation(s)
- Arianna Miglio
- Department of Veterinary Medicine, University of Perugia, Via San Costanzo 4, 06126 Perugia, Italy;
| | - Carlotta Valente
- Department of Animal Medicine, Production and Health, University of Padua, Viale dell’Università 16, 35020 Legnaro, Italy;
| | - Carlo Guglielmini
- Department of Animal Medicine, Production and Health, University of Padua, Viale dell’Università 16, 35020 Legnaro, Italy;
- Correspondence:
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Scalco R, Aleman M, Nogueira CEW, Freitas NB, Curcio BR. Red cell distribution width values and red cell distribution width-to-platelet ratio in Thoroughbred foals in the first 24 hours of life. J Vet Emerg Crit Care (San Antonio) 2023; 33:217-222. [PMID: 36537889 DOI: 10.1111/vec.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 02/19/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To report red cell distribution width (RDW) values, to calculate RDW-to-platelet ratio (RPR), and to investigate a possible correlation of RDW and RPR index values in neonatal foals classified as healthy or at risk based on clinical information from a population of foals up to 24 hours of life. DESIGN Retrospective study conducted from records and CBCs of foals born between June and November from 2018 to 2020 foaling seasons. SETTING Breeding farm. ANIMALS Three hundred and nine neonatal full-term Thoroughbred foals. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Foals were evaluated by a veterinarian within 15 minutes after birth, and a blood sample was collected within 24 hours of life. Based on clinical information, 88 of 309 foals (28.4%) were considered at risk of perinatal disease, and 201 were healthy. Mean gestational age for the foals was 346.3 ± 9.7 days. RDW values did not differ between groups. Gestational length demonstrated to have a negative correlation with RDW (r = -0.156, P = 0.005) and mean corpuscular volume (r = -0.135, P = 0.01), indicating a link of these variables to foal maturity. RPR index was higher for at-risk (0.073 ± 0.018) than for healthy foals (0.068 ± 0.014, P = 0.01). CONCLUSION RPR might be a promising early indicator of disease for the field triage of neonatal foals.
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Affiliation(s)
- Rebeca Scalco
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Monica Aleman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, Davis, California, USA
| | - Carlos E W Nogueira
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Natalia B Freitas
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Bruna R Curcio
- Departamento de Clínicas Veterinária, Faculdade de Medicina Veterinária, Universidade Federal de Pelotas, Pelotas, Rio Grande do Sul, Brazil
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Li J, Gao W, Liu J, Zhang X, Tao J, Zhang G. Red blood cell distribution width and maximum left ventricular wall thickness predict poor outcomes in patients with hypertrophic cardiomyopathy. Echocardiography 2022; 39:278-285. [PMID: 35066909 DOI: 10.1111/echo.15303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/05/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jia Li
- Department of Cardiology The Jiangmen Central Hospital The Jiangmen Central Hospital of Sun Yat‐Set University Jiangmen China
- Department of Cardiology The First Affiliated Hospital of Sun Yat‐sen University Guangzhou China
- Grade 17, Sun Yat‐sen University Zhongshan School of Medicine Sun Yat‐sen University Guangzhou China
| | - Weidong Gao
- Department of Cardiology The Jiangmen Central Hospital The Jiangmen Central Hospital of Sun Yat‐Set University Jiangmen China
| | - Jinxue Liu
- Department of Cardiology The Jiangmen Central Hospital The Jiangmen Central Hospital of Sun Yat‐Set University Jiangmen China
| | - Xuefang Zhang
- Department of Cardiology The Jiangmen Central Hospital The Jiangmen Central Hospital of Sun Yat‐Set University Jiangmen China
| | - Jun Tao
- Department of Cardiology The First Affiliated Hospital of Sun Yat‐sen University Guangzhou China
| | - Gaoxing Zhang
- Department of Cardiology The Jiangmen Central Hospital The Jiangmen Central Hospital of Sun Yat‐Set University Jiangmen China
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Ludwik TM, Heinrich DA, Rendahl A, Friedenberg SG. Red cell distribution width is a predictor of all-cause mortality in hospitalized dogs. J Vet Emerg Crit Care (San Antonio) 2022; 32:9-17. [PMID: 34432939 PMCID: PMC9272852 DOI: 10.1111/vec.13109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To determine whether RBC distribution width (RDW) is associated with an increased odds of mortality in hospitalized dogs and cats. DESIGN Retrospective, single-center study; data collected from 2007 to 2017. SETTING University teaching hospital. ANIMALS Six thousand six hundred and sixty-one animals (5183 dogs and 1478 cats). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Medical records were identified from animals presented to the emergency service and admitted to the ICU with a CBC and serum biochemistry performed on admission. Patients were stratified into quintiles based upon presenting RDW, and logistic regression modeling was performed to evaluate the relationship between RDW and in-hospital mortality. Canine patients with a presenting RDW in the upper fourth and fifth quintiles had an increased odds of all-cause in-hospital mortality (p < 0.0001). Specifically, dogs in the upper fifth quintile had a 2.1-fold greater odds of death compared to dogs in the first quintile, and dogs in the upper fourth quintile had a 1.9-fold greater odds of death compared to dogs in the first quintile. This relationship remained significant after adjusting for age, sex, key laboratory values excluding HCT, medical versus surgical disease, and diagnosis category. This relationship was no longer significant with the inclusion of HCT. No significant association was identified between presenting RDW and in-hospital mortality in cats. CONCLUSIONS Hospitalized dogs with higher RDW on presentation to the emergency service have greater odds of all-cause in-hospital mortality compared to dogs with a lower RDW. A similar association between RDW and mortality was not found in cats. Further studies are warranted to assess the usefulness of this biomarker for specific diseases in dogs and to better understand the mechanisms driving the association between increased RDW and mortality in canine patients.
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Affiliation(s)
- Tasia M Ludwik
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Daniel A Heinrich
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Aaron Rendahl
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
| | - Steven G Friedenberg
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota, USA
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Garcia-Arce M, Gow AG, Handel I, Ngoi W, Thomas E. Retrospective evaluation of red blood cell distribution width as a prognostic factor in critically ill dogs (December 2016 to April 2017): 127 cas. J Vet Emerg Crit Care (San Antonio) 2021; 32:405-412. [PMID: 34962694 DOI: 10.1111/vec.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 07/25/2020] [Accepted: 08/06/2020] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the association between RBC distribution width (RDW) and in-hospital mortality, length of hospitalization, and leukocyte count in critically ill dogs. DESIGN Retrospective study. SETTING University teaching hospital. ANIMALS One hundred and twenty-seven dogs admitted to the ICU from December 2016 to April 2017. Patients were included if they had a CBC performed within the first 24 h of admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The overall in-hospital mortality rate was 29% (37/127), and median length of hospital stay was 3 days (interquartile range [IQR], 5). The median RDW value was 13.8% (IQR, 1.6%; reference interval, 11.9%-14.5 %). The canine Acute Patient Physiologic and Laboratory Evaluation (APPLE) fast score was calculated in 81 of 127 (64%) patients; the median score was 24/50 (IQR, 9). There was no significant correlation between RDW and APPLE fast score (P = 0.163). Subgroup analysis was performed according to the following diagnostic categories: abdominal (36%; 46/127), hematological (13%; 16/127), respiratory (13%; 16/127), neurological (12%; 15/127), cardiovascular (11%; 14/127), integument (3%; 4/127), trauma (3%; 4/127), musculoskeletal (2%; 3/127), and others (7%; 9/127). Increased RDW was not associated with in-hospital mortality overall (P = 0.381) or in any individual subgroup analysis. No association was found between length of hospitalization and RDW values in either survivors (P = 0.548) or nonsurvivors (P = 0.083). The correlation between RDW and leukocyte count was nonsignificant (P = 0.12). CONCLUSIONS In this study, admission RDW was not associated with in-hospital mortality or length of hospitalization in critically ill dogs. The correlation between RDW and leukocyte count was nonsignificant.
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Affiliation(s)
- Marta Garcia-Arce
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Adam G Gow
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Ian Handel
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Waiyin Ngoi
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
| | - Emily Thomas
- The Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, UK
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8
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Prognostic value of red blood cell distribution width for mortality in patients with hypertrophic cardiomyopathy. Clin Biochem 2021; 96:19-25. [PMID: 34245695 DOI: 10.1016/j.clinbiochem.2021.07.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/15/2021] [Accepted: 07/05/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Red blood cell distribution width (RDW) has emerged as a useful indicator for adverse outcomes in several cardiovascular diseases. The relation between RDW and the prognosis of hypertrophic cardiomyopathy (HCM) remains to be evaluated. We examined the relation between RDW and all-cause mortality and HCM-related death in a population of adult HCM patients. METHODS We performed clinical evaluation in 414 consecutive adult HCM patients (median age, 57.5 years; male, 54.8%). RESULTS During a median follow-up of 3.7 years, all-cause mortality and HCM-related death occurred in 75 (18.1%) and 50 (12.1%) patients, respectively. Based on the tertiles of baseline RDW, mortality increased with higher tertile. With the tertile 1 as reference, adjusted all-cause mortality hazard ratios (HRs) were 3.9 for the tertile 2 (95% confidence interval [CI]: 1.5-10.3) and 3.1 for the tertile 3 (95% CI: 1.1-8.2). Adjusted HCM-related death HRs were higher in the tertile 2 (HR: 5.5; 95% CI: 1.2-24.4) and tertile 3 (HR: 6.6; 95% CI: 1.5-29.0) compared with the tertile 1. Further smooth curve fitting exhibited a saturation effect after adjusting for confounders, and there were a two-stage change and an inflection point. Two-piecewise Cox model suggested mortality significantly increased with RDW level up to the inflection point (about 14.0% for both all-cause mortality and HCM-related death), and RDW was not associated with mortality after the point. CONCLUSION In adult HCM patients, we found increased RDW was a significant risk predictor for all-cause mortality and HCM-related death, and a saturation effect was observed.
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Updates on Laboratory Evaluation of Feline Cardiac Diseases. Vet Sci 2021; 8:vetsci8030041. [PMID: 33802401 PMCID: PMC8000286 DOI: 10.3390/vetsci8030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 11/17/2022] Open
Abstract
Laboratory tests can be altered in cardiovascular diseases and the investigation of specific tests or biomarkers may provide additional information about myocardial damage. Traditional laboratory tests, such as cell blood count, serum biochemistry, and coagulation, can be useful in investigating patients, but are not specific. However, markers like Troponin and Natriuretic Peptides may possibly furnish further data on myocardium damage and can be used in both studying and monitoring cats with cardiac disease. Moreover, the evaluation of the thyroid profile is very important as hyperthyroid cats concomitant cardiovascular diseases are very common and they can also be a direct consequence of endocrinopathy. The purpose of this manuscript is to provide the widest possible overview of what is present in the literature about the feline clinical pathology of heart diseases through a rational division of the main alterations of traditional tests and biomarkers.
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Yang HJ, Liu X, Qu C, Shi SB, Liang JJ, Yang B. Usefulness of Red Blood Cell Distribution Width to Predict Heart Failure Hospitalization in Patients with Hypertrophic Cardiomyopathy. Int Heart J 2018; 59:779-785. [DOI: 10.1536/ihj.17-507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Hong-Jie Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University
- Cardiovascular Research Institute, Wuhan University
- Hubei Key Laboratory of Cardiology
| | - Xin Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University
- Cardiovascular Research Institute, Wuhan University
- Hubei Key Laboratory of Cardiology
| | - Chuan Qu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University
- Cardiovascular Research Institute, Wuhan University
- Hubei Key Laboratory of Cardiology
| | - Shao-Bo Shi
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University
- Cardiovascular Research Institute, Wuhan University
- Hubei Key Laboratory of Cardiology
| | - Jin-Jun Liang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University
- Cardiovascular Research Institute, Wuhan University
- Hubei Key Laboratory of Cardiology
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan University
- Cardiovascular Research Institute, Wuhan University
- Hubei Key Laboratory of Cardiology
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