Relation of red cell distribution width with the presence, severity, and complexity of coronary artery disease. Coron Artery Dis. 2012;23:51-56. [PMID: 22133925 DOI: 10.1097/mca.0b013e32834e4f5c]

Role of Parameters in Whole Blood Analysis as in Indicator of Systemic Inflammation in Children with Rheumatic Valve Diseases

PURPOSE

The most important cause of mortality and morbidity in acute rheumatic fever (ARF) is carditis and rheumatic heart disease (RHD). The aim of this study was to identify markers that may be indicators of chronic inflammation in whole blood analyses in pediatric patients with RHD who regularly received secondary deposilin prophylaxis.

METHODS

In our study, 100 children with ARF aged between 4 and 18 years were followed up in the pediatric cardiology outpatient clinic of the patient group. The control group consisted of 100 healthy children of the same sex and age as the patient group. All children in the patient group regularly received deposilin prophylaxis every 21 days. Our study included many whole blood parameters that are reported in the literature to represent changes in chronic inflammatory diseases. These parameters were CRP, RDW, PDW, MPV and leukocyte subtypes, neutrophil, lymphocyte, monocyte counts and their ratios (neutrophil/lymphocyte, platelet/lymphocyte and monocyte/lymphocyte).

RESULTS

Leukocyte count, lymphocyte count, basophil count, MLR and basophil count were significantly lower in the patient group than in the control group (p: 0.047, p: 0.023, p: 0.006). In addition, eosinophil count and RDW value were significantly higher in the patient group than in the control group (p: 0.043; p: 0.001).

CONCLUSION

In our study, low leukocyte, lymphocyte, basophil, MLR and higher eosinophil counts indicated that RDW could be effectively used as a marker for regular depositilin prophylaxis in pediatric patients with RHD.

Association between red blood cell distribution width-to-platelet ratio and post-discharge readmission rate in patients with heart failure: A retrospective cohort study

Background

To date, no studies have investigated the association between red blood cell distribution width (RDW)-to-platelet ratio (RPR) and readmission rates among patients with heart failure (HF). As such, the present study aimed to examine the relationship between RPR and readmission rates in patients with HF.

Methods

Data for this study were obtained from the Fourth People's Hospital (Zigong, Sichuan Province, China). Patients were diagnosed with HF in accordance with European Society of Cardiology criteria. The primary outcome was the 28-day readmission rate. Various logistic regression models were constructed to explore the association between RPR and the 28-day readmission rate.

Results

The study comprised 1978 patients with HF, with a 28-day readmission rate of 6.98%. RPR emerged as an independent risk factor for 28-day readmission, evidenced by consistent results across the various regression-adjusted models. The covariate-adjusted propensity score model demonstrated that every 0.1 increase in RPR was associated with an 8.2% increase in 28-day readmission rate (odds ratio [OR] 1.082 [95% confidence interval (CI) 1.012-1.158]; P = 0.0212). Similarly, each 0.1 change in RPR was associated with a 9.8% (OR 1.098 [95% CI 1.014-1.188]) and 7.3% (OR 1.073 [95% CI 0.991-1.161]) increase in 3- and 6-month readmission rates, respectively. However, RPR was not statistically associated with the 6-month readmission rate. Curve fit plots illustrated a nonlinear positive correlation between RPR and 28-day, and 3- and 6-month readmissions. Moreover, the effects of RPR on 28-day, and 3- and 6-month readmission rates remained robust across subgroup variables in stratified analysis. Finally, the effect sizes of pooled multiply imputed data were consistent with the original data, suggesting robust results.

Conclusion

RPR was an independent risk factor for 28-day readmission among patients with HF and also demonstrated modest predictive value for readmissions at 3 and 6 months, despite being non-significant for the 6-month readmission rate. Early identification of patients with HF with elevated RPR would facilitate management and may confer favorable effects on prognosis.

Red blood cell distribution width (RDW) - A new nutritional biomarker to assess nutritional risk and response to nutritional therapy?

BACKGROUND & AIMS

Red cell distribution width (RDW) has been proposed as a surrogate marker for acute and chronic diseases and may be influenced by nutritional deficits. We assessed the prognostic value of RDW regarding clinical outcomes and nutritional treatment response among medical inpatients at nutritional risk.

METHODS

This is a secondary analysis of EFFORT, a randomized, controlled, prospective, multicenter trial investigating the effects of nutritional support in patients at nutritional risk in eight Swiss hospitals. We examined the association between RDW and mortality in regression analysis.

RESULTS

Among 1,244 included patients (median age 75 years, 46.6 % female), high RDW (≥15 %) levels were found in 38 % of patients (n = 473) with a significant association of higher malnutrition risk [OR 1.48 (95%CI 1.1 to 1.98); p = 0.009]. Patients with high RDW had a more than doubling in short-term (30 days) mortality risk [adjusted HR 2.12 (95%CI 1.44 to 3.12); p < 0.001] and a signficant increase in long-term (5 years) mortality risk [adjusted HR 1.73 (95%CI 1.49 to 2.01); p < 0.001]. Among patients with high RDW, nutritional support reduced morality within 30 days [adjusted OR 0.56 (95%CI 0.33 to 0.96); p = 0.035], while the effect of the nutritional intervention in patients with low RDW was markedly smaller.

CONCLUSIONS

Among medical patients at nutritional risk, RDW correlated with several nutritional parameters and was a strong prognostic marker for adverse clinical outcomes at short- and long-term, respectively. Patients with high baseline RDW levels also showed a strong benefit from the nutritional intervention. Further research is needed to understand whether monitoring of RDW over time severs as a nutritional biomarker to assess effectiveness of nutritional treatment in the long run.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02517476.

Association between polycyclic aromatic hydrocarbons exposure with red cell width distribution and ischemic heart disease: insights from a population-based study

This study investigates the association between polycyclic aromatic hydrocarbon (PAH) exposure, red blood cell distribution width (RDW), and ischemic heart disease (IHD) in a sample of 3003 participants from the National Health and Nutrition Examination Survey (NHANES). We hypothesize that RDW may mediate the effect of hydroxylated PAHs (OH-PAH) on IHD. Logistic regression models reveal significant associations between increased urinary PAH metabolite concentrations and IHD, as well as positive associations between PAH metabolites and RDW. Weighted Quantile Sum (WQS) regression and Bayesian Kernel Machine Regression (BKMR) analyses confirm the significant associations of the OH-PAH mixture with IHD and RDW. Mediation analysis demonstrates that RDW partially mediates the relationship between PAH exposure and IHD, accounting for 2-4.6% of the total effects. Our findings highlight the potential underlying mechanisms linking PAH exposure, RDW, and IHD and emphasize the importance of addressing environmental pollutants like PAHs in maintaining cardiovascular health and informing public health policies.

Is red cell distribution width a prognostic factor in patients with breast cancer? A meta-analysis

Purpose

The current study aimed to investigate whether red blood cell distribution width (RDW) can predict the prognosis of patients with breast cancer (BC).

Methods

We searched four databases, including PubMed, Embase, Cochrane Library databases, and CNKI, from inception to Jun 13, 2022. The primary outcome was overall survival (OS), and the secondary outcome was disease-free survival (DFS). A subgroup analysis was conducted based on different treatments. This meta-analysis was performed with RevMan 5.3 (The Cochrane Collaboration, London, United Kingdom).

Results

A total of seven studies including 4,884 BC patients were identified. The high RDW group had a larger tumor size (OR = 2.12, 95% CI = 1.67 to 2.68, P < 0.01), higher proportions of advanced stage tumors (OR = 1.77, 95% CI = 1.38 to 2.27, P < 0.01), more lymph node metastases (OR = 2.00, 95% CI = 1.58 to 2.51, P < 0.01) and lower HER-2 expression (OR = 0.76, 95% CI = 0.61 to 0.95, P = 0.02). For prognosis, after pooling all the data, we found that the high RDW group was associated with worse OS (HR = 2.12, 95% CI = 1.47 to 3.08, P < 0.01) and DFS (HR = 1.77, 95% CI = 1.32 to 2.37, P < 0.01). The subgroup analysis found that RDW had prognostic significance but only for surgery-only patients (HR = 2.41, 95% CI = 1.67 to 3.49, P < 0.01).

Conclusion

High RDW was associated with worse OS and DFS. Therefore, RDW was a simple predictive factor for the prognosis of BC patients.

Preoperative red cell distribution width to lymphocyte ratio as biomarkers for prolonged intensive care unit stay among older patients undergoing cardiac surgery: a retrospective longitudinal study

Introduction: Our aim was to use the red cell distribution width-lymphocyte ratio (RLR) as a novel biomarker to predict prolonged intensive care unit (ICU) length of stay (LOS) among older patients undergoing cardiovascular surgery. Methods: This longitudinal study included older patients admitted to a tertiary cardiovascular surgery hospital between January 2017 and January 2022. Results: A total of 574 patients were studied, including 83 patients (14.5%) who had prolonged ICU LOS and 471 (85.5%) control subjects. After adjustment for the European System for Cardiac Operative Risk Evaluation 2, the RLR score showed a 10% increased risk of prolonged ICU LOS (odds ratio: 1.10; CI: 1.05-1.16; p = 0.01). Conclusion: Preoperative RLR can be used to predict the risk of long-term intensive care stay in older cardiac surgery patients.

Dynamic Changes in Red Cell Distribution Width Can Predict Major Adverse Cardiovascular Events after PCI in Patients with Unstable Angina Pectoris: A Retrospective Cohort Study

Background

The increased red cell distribution width (RDW) is related to a higher risk for cardiovascular disease (CVD). However, it is yet unclear whether the dynamic change of RDW is associated with the major adverse cardiovascular events (MACEs) for individual with CVD.

Methods and Results

A cohort study was conducted among 228 patients who had unstable angina (UA) and underwent PCI. RDW was measured preceding PCI and re-measured on the 16th week after PCI. The change of RDW values was defined as ΔRDW. The patients were divided into 3 groups in accordance with ΔRDW: improved, stable, and worsened RDW groups. The patients were followed up for 6 years, and MACE episodes were recorded. The survival analysis showed that the incidence of MACEs in stable RDW group was significantly lower than that in improved and worsened RDW groups. By the COX model, the risk of the occurrence of cardiovascular events in improved RDW group was 1.661 times higher than the risk in stable RDW group (HR =1.661, 95% CI: 1.583-2.880, p < 0.05) and the same situation was 3.307 times higher in worsened RDW group (HR =3.307, 95% CI: 1.830-5.041, p < 0.05).

Conclusion

The measurement of ΔRDW has potential to predict the MACEs in UA patients underwent PCI. The dynamic changes in RDW are associated with the outcome of CVD.

The Relationship between Red Cell Distribution Width and Residual SYNTAX Scores in ST-Segment Elevation Myocardial Infarction Patients after Percutaneous Coronary Intervention

OBJECTIVE

Residual SYNTAX score (rSS) values have been suggested to serve as an independent predictor of mortality in ST-segment elevation myocardial infarction (STEMI) patients following percutaneous coronary intervention (PCI). Prior work has also indicated that red cell distribution width (RDW) can predict the incidence of major adverse cardiac events (MACEs) in STEMI patients. As such, we sought to explore the relationship between RDW and rSS in STEMI patients that have undergone PCI.

METHODS

In total, 456 eligible patients were recruited for this study. Youden's index was used to calculate the optimal RDW cut-off value, after which the relationship between RDW and rSS values was assessed through Spearman's correlation analyses. Independent predictors of high rSS levels were then identified via multivariate logistic regression analysis.

RESULTS

Patients were separated into two groups based upon whether they exhibited high RDW levels (>13.9, Group 1) or low RDW levels (<13.9, Group 2). The average rSS value of patients in Group 2 was found to be significantly decreased compared to patients in Group 1 (P < 0.001). RDW values were found to be positively correlated with rSS (r = 0.604, P < 0.001), and multivariate logistic regression analysis determined that high RDW levels were independently predictive of higher rSS (OR = 27.1 [14.8-51.7]; P < 0.001). Additionally, a nomogram incorporating RDW exhibited good calibration, discriminative capacity, and clinical utility.

CONCLUSIONS

In summary, RDW is strongly correlated with rSS in STEMI patients following PCI, with high RDW levels serving as an independent predictor of high rSS in this patient population.

Simple Laboratory Test-Based Risk Scores in Coronary Catheterization: Development, Validation, and Comparison to Conventional Risk Factors

BACKGROUND

We developed and validated laboratory test-based risk scores (i.e., lab risk scores) to reclassify mortality risk among patients undergoing their first coronary catheterization.

METHODS

Patients were catheterized between 2009 and 2015 in Calgary, Alberta, Canada (n = 14 135, derivation cohort), and in Edmonton, Alberta, Canada (n = 12 143, validation cohort). Logistic regression with group LASSO (least absolute shrinkage and selection operator) penalty was used to select quintiles of the last laboratory tests (red blood cell count, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red cell distribution width, platelet count, total white blood cell count, plasma sodium, potassium, chloride, CO2, international normalized ratio, estimated glomerular filtration rate) performed <30 days before catheterization and by age and sex that were significantly associated with death ≤60  and >60 days after catheterization. Follow-up was until 2016. Risk scores were developed from significant tests, internally validated in Calgary among bootstrap samples and externally validated in Edmonton after recalibration using coefficients developed in Calgary. Interaction tests were performed, and net reclassification improvement vs conventional demographic and clinical risk factors was determined.

RESULTS

Lab risk scores were strongly associated with mortality (29-40× for top vs bottom quintile, P for trends <0.01), had good discrimination and were well calibrated in Calgary (C = 0.80-0.85, slope = 0.99-1.01) and Edmonton (C = 0.80-0.82; slope = 1.02-1.05)-similar to demographic and clinical risk factors alone. Associations were attenuated by several comorbidities; however, scores appropriately reclassified 11%-20% of deaths (both follow-up periods) and 6%-9% of survivors (>60 days) after catheterization vs demographic and clinical risk factors.

CONCLUSIONS

In 2 populations of patients undergoing their first coronary catheterization, risk scores based on simple laboratory tests were as powerful as a combination of demographic and clinical risk factors in predicting mortality. Lab risk scores should be used for patients undergoing coronary catheterization.

The Effect of Red Cell Distribution Width Admission Value on the Outcome of Patients with First-ever ST-elevation Myocardial Infarction in Basrah

Background Red cell distribution width (RDW) reflects the volumetric heterogeneity of red blood cells (RBCs) and has proven to be a prognostic predictor for cardiovascular (CV) morbidity and mortality in ST-elevation myocardial infarction (STEMI). The study aims to evaluate the effect of the RDW admission value on the outcome of patients with STEMI. Materials and methods This is a cross-sectional observational study on (207) patients with first-ever STEMI, grouped according to their baseline RDW and thrombolysis eligibility into two groups. We calculated the in-hospital Global Registry of Acute Coronary Events (GRACE) score within 48 hours of presentation. Results The study demonstrated the impact of RDW on the primary STEMI outcomes (left ventricular ejection fraction (LVEF%), ST-resolution, arrhythmias, and cardiovascular mortality risk). It was nearly a gender-matched study, with a mean RDW of 14.20±1.86%. RDW>14% and age≥65 years were the strongest statistically significant independent predictors of STEMI outcome with LVEF % < 45%, ST-resolution, and CV mortality regardless of thrombolysis. The thrombolysis offers a logical significant negative relation with CV mortality. At the same time, hypertension, diabetes mellitus (DM), and smoking may cause an additional mortality burden, especially in elderly patients with high RDW who are not eligible for thrombolysis. There was a significant association between high GRACE to high RDW, with excellent specificity and sensitivity in predicting CV outcome. Conclusion The RDW is a simple to acquire index, with a good prognostic prediction of major adverse cardiovascular events (MACEs) and CV mortality in the STEMI patients. It is excellent in predicting STEMI outcomes, especially the response to thrombolysis.

R/S ratio in lead II, and the prognostic significance of red cell distribution width in acute coronary syndrome

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.

Correlation Between Red Cell Distribution Width and Peripheral Vascular Disease Severity and Complexity

A traditional hematological marker, red cell distribution width (RDW), is accepted as a novel marker of atherosclerotic vascular diseases. Clinical importance of the RDW as a prognostic biomarker in peripheral vascular disease (PVD) has been reported in a few studies. Herein, we aimed to show the correlation between RDW and PVD severity and its complexity in terms of angiographic evaluation. A total of 118 patients who underwent peripheral lower extremity angiography were subsequently evaluated retrospectively. Upon admission, RDW level was measured with automated complete blood count. Severity and complexity of the PVD was evaluated according to Trans-Atlantic Inter-Society Consensus (TASC II) classification. A TASC II A-B lesion was defined as simple PVD, and a TASC II C-D lesion was defined as prevalent and complex PVD. Then, both groups were compared statistically according to clinical, laboratory, and demographic features, including RDW levels. In 49.6% of the patients, TASC II C-D lesions were observed. Advanced age, male gender, and body mass index (BMI) were associated with TASC II groups. Red cell distribution width levels were correlated with presence of PVD, as well as TASC II grades (p:0.02). The fourth quartile (75th percentile) of the RDW levels was 14.1, and patients with RDW levels ≥14.1 had a more significant correlation with the presence and severity of PVD (p:0.001). In the multivariate regression analysis, elevated RDW was found to be an independent predictor of the presence of PVD and also TASC II C-D lesions (OR:2.26, with a 95% confidence interval (CI) 0.051-0.774; p:0.02). Elevated RDW levels was associated with TASC II C-D lesions, which indicated more prevalent and complex PVD.

Predicting of neuropsychosis in carbon monoxide poisoning according to the plasma troponin, COHb, RDW and MPV levels: Neuropsychoses in carbon monoxide poisoning

OBJECTIVE

Carbon monoxide (CO) poisoning is very common worldwide. In this study, we aimed to evaluate the predictivity of neuro psychosis in carbon monoxide poisoning by the admission levels of red cell distribution (RDW), mean platelet volume (MPV) and troponin I levels which can be measured quickly and easily in the emergency department (ED).

PATIENTS AND METHODS

This single center observational study included a total of 216 consecutive patients who presented to the ED due to CO poisoning between January 2009 and December 2013. The diagnosis of CO poisoning was made according to the medical history and carboxyhemoglobin (COHb) level of >5%. According to the carboxyhemoglobin levels, the patients were classified as mildly (COHb < 20%) and severely poisoned (COHb > 20%). In addition, patients were divided into 2 groups, i.e., those with positive (>0.05 ng/mL for our laboratory) and negative (<0.05 ng/mL for our laboratory) troponin levels.

RESULTS

Patients mean age was 52.58 ± 10.58. 57.9% of the patients had high troponin levels and 51.9% were poisoned severely according to COHb levels. Patients with positive troponin and COHb had longer CO exposure time and higher neutrophil, lymphocyte, mean platelet volume (MPV), COHb and red cell distribution width (RDW) levels at the index admission following CO poisoning than patients with negative troponin (p < 0.05). Age, COHb level, CO exposure time, MPV and RDW (p = 0.001, p < 0.05) remained associated with an increased risk of troponin positivity following adjustment for the variables that were statistically significant.

CONCLUSIONS

In patients presenting to the ED with CO poisoning, RDW and MPV can be helpful for risk stratification of neuropsychosis.

The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective

The red blood cell distribution width (RDW) is an index of the heterogeneity of circulating red blood cell size, which along with other standard complete blood count (CBC) parameters are used to identify hematological system diseases. Besides hematological disorders, several clinical studies have shown that an increased in the RDW may be associated with other diseases including acute pancreatitis, chronic kidney disease, gastrointestinal disorders, cancer, and of special interest in this review, cardiovascular disease (CVD). The diagnostic and prognostic value of RDW in different CVD (acute coronary syndrome, ischemic cerebrovascular disease, peripheral artery disease, atrial fibrillation, heart failure, and acute ischemic stroke) has been reviewed in this article, to provide an understanding how its measurement may be applied to improve the management of these conditions.

Blood Cell Parameters and Predicting Coronary In-Stent Restenosis

Major advances in coronary interventional techniques and pharmacotherapy as well as the use of drug-eluting stents (DESs) have considerably reduced the risk of in-stent restenosis (ISR). However, ISR remains a major clinical challenge. Inflammation and platelet activation are important processes that underlie the pathophysiology of ISR. Parameters related to blood cells, entailing both cell count and morphology, are useful markers of the inflammatory response and platelet activation in clinical practice. Recent studies have highlighted several new combined or derived parameters related to blood cells that independently predict ISR after DES implantation. The neutrophil/lymphocyte ratio, an inflammatory marker, is regarded as a predictor of the risk of ISR and the stability of atherosclerotic plaques. The mean platelet volume, a widely used platelet activation parameter, has been shown to be a predictor of the risk of ISR and the efficacy of antiplatelet therapy. Other markers considered include the platelet/lymphocyte ratio, red blood cell distribution width, and platelet distribution width. This review provides an overview of these parameters that may help stratify the risk of coronary angiographic and clinical outcomes related to ISR.

Red Cell Distribution Width and Mortality in Patients With Acute Coronary Syndrome: A Meta-Analysis on Prognosis

Background

Red cell distribution width (RDW), a routine component of the complete blood count (CBC), measures variation in the size of circulating erythrocytes. It has been associated with several clinical outcomes in cardiovascular disease. We sought to strengthen the association between RDW and mortality in patients admitted for acute coronary syndrome (ACS) by pooling together data from available studies.

Methods

Studies that fulfilled the following were identified for analysis: 1) observational; 2) included patients admitted for ACS; 3) reported data on all-cause or cardiovascular (CV) mortality in association with a low or high RDW; and 4) used logistic regression analysis to control for confounders. Using MEDLINE, Clinical Key, ScienceDirect, Scopus, and Cochrane Central Register of Controlled Trials databases, a search for eligible studies was conducted until January 9, 2017. The quality of each study was evaluated using the Newcastle-Ottawa Quality Assessment Scale. Our primary outcome of interest was all-cause or CV mortality. We also investigated the impact of RDW on major adverse cardiovascular events (MACEs) for the studies that reported these outcomes. Review Manager (RevMan) 5.3 was utilized to perform Mantel-Haenzel analysis of random effects and compute for relative risk.

Results

We identified 13 trials involving 10,410 patients, showing that in ACS, a low RDW is associated with a statistically significant lower all-cause or CV mortality (RR 0.35, (95% CI 0.30 to 0.40), P < 0.00001, I² = 53%), a finding that was consistent both in the short- and long-term.

Conclusions

A low RDW is also associated with lower risk for MACEs after an ACS (RR 0.56, (95% CI 0.51 to 0.61), P < 0.00001, I² = 91%). A low RDW during an ACS is associated with lower all-cause or CV mortality and lower risk of subsequent MACEs, providing us with a convenient and inexpensive risk stratification tool in ACS patients.

Red Blood Cell Distribution Width Is Associated with Carotid Atherosclerosis in People with Type 2 Diabetes

AIMS

Red cell distribution width (RDW) has been shown to be associated with cardiovascular diseases (CVD). The relationship between RDW and carotid intima-media thickness (C-IMT), a marker of subclinical atherosclerosis, has been inconsistent in subjects with cardiovascular risk factors. In this study, we investigated the relationship between RDW and carotid atherosclerosis in people with type 2 diabetes.

METHODS

Four hundred sixty-nine people with type 2 diabetes without history of cardiovascular or cerebrovascular diseases were enrolled. Anthropometric measures and various biochemical parameters including RDW were assessed. Ultrasonographic measurement of carotid intima-media thickness was used to evaluate subclinical atherosclerosis.

RESULTS

The participants were stratified into 3 groups according to RDW. The C-IMT increased gradually according to RDW tertiles (lowest, second, highest RDW tertiles; 0.740 ± 0.120, 0.772 ± 0.138, and 0.795 ± 0.139, respectively; p < 0.01). Multiple regression analysis and multivariate logistic regression analysis revealed that RDW was associated with C-IMT in people with type 2 diabetes, and it remained significant after control for various cardiovascular risk factors including body mass index, blood pressure, insulin resistance, and smoking status in multivariate logistic regression analysis.

CONCLUSION

RDW is associated with subclinical atherosclerosis assessed by carotid IMT after control of various covariates in people with type 2 diabetes without cardiovascular or cerebrovascular diseases.

Monocyte gene expression in childhood obesity is associated with obesity and complexity of atherosclerosis in adults

Childhood obesity coincides with increased numbers of circulating classical CD14⁺⁺CD16^- and intermediate CD14⁺⁺CD16⁺ monocytes. Monocytes are key players in the development and exacerbation of atherosclerosis, which prompts the question as to whether the monocytosis in childhood obesity contributes to atherogenesis over the years. Here, we dissected the monocyte gene expression profile in childhood obesity using an Illumina microarray platform on sorted monocytes of 35 obese children and 16 lean controls. Obese children displayed a distinctive monocyte gene expression profile compared to lean controls. Upon validation with quantitative PCR, we studied the association of the top 5 differentially regulated monocyte genes in childhood obesity with obesity and complexity of coronary atherosclerosis (SYNTAX score) in a cohort of 351 adults at risk for ischemic cardiovascular disease. The downregulation of monocyte IMPDH2 and TMEM134 in childhood obesity was also observed in obese adults. Moreover, downregulation of monocyte TMEM134 was associated with a higher SYNTAX atherosclerosis score in adults. In conclusion, childhood obesity entails monocyte gene expression alterations associated with obesity and enhanced complexity of coronary atherosclerosis in adults.

Medical significance of simultaneous application of red blood cell distribution width (RDW) and neopterin as diagnostic/prognostic biomarkers in clinical practice

In our individual and collaborative studies, we have played a part in pioneering investigations on the usefulness of biomarkers – red blood cell distribution width (RDW) and neopterin. This mini review includes historical data on the topic and is related to the first contributions in this field, as well as to the possibilities for further improvement and simultaneous application of RDW and neopterin measurements in the prevention, prognosis and treatment of a great number of socially important disease conditions (arterial, cardiovascular, brain vascular, peripheral artery diseases, inflammations, autoimmune states, cancers and leukemias, addictions, etc.). When comparing the results obtained with the immunobiochemical biomarker neopterin with RDW, they are reported to be very similar as independent predictors of the same pathological states in the human body although their biomedical origins are very different. Both the parameters were until now successfully, but only separately used in medical practice. The combined use of these two biomarkers can shed some more light on their interrelationships and provide some clues as to how the interaction between immune system activation and red blood cells biology are intertwined.

Red cell distribution width is correlated with extensive coronary artery disease in patients with diabetes mellitus

Introduction:

Previous studies have predicted an independent relationship between red cell distribution width (RDW) and the risk of death and cardiovascular events in patients with coronary artery disease (CAD). The aim of this study was to investigate the relationship between RDW and extensiveness of CAD in patients with diabetes mellitus (DM).

Methods:

Two hundred and thirty-three diabetic patients who underwent coronary angiographies at our centre in 2010 were included in the study. All of the angiograms were re-evaluated and Gensini scores were calculated. Triple-vessel disease wasdiagnosed in the presence of stenosis > 50% in all three coronary artery systems.

Result:

RDW was significantly higher in diabetic CAD patients (p < 0.001). Patients with CAD who had a RDW value above the cut-off point also had higher Gensini scores, higher percentages of obstructive CAD and triple-vessel disease (p ≤ 0.001 for all). According to the cut-off values calculated using ROC analysis, RDW > 13.25% had a high diagnostic accuracy for predicting CAD. RDW was also positively correlated with Gensini score, obstructive CAD and triple-vessel disease (r < 0.468 and p < 0.001 for all).

Conclusion:

RDW values were found to be increased in the diabetic CAD population. Higher RDW values were related to more extensive and complex coronary lesions in patients with DM.

Brief Report: Elevated Red Cell Distribution Width Identifies Elevated Cardiovascular Disease Risk in Patients With HIV Infection

Red cell distribution width (RDW) is linked to cardiovascular risk in the general population, an association that might be driven by inflammation. Whether this relationship holds for patients with HIV infection has not been previously studied. Using a large clinical registry, we show that elevated RDW (>14.5%) is independently associated with increased risk of coronary artery disease {odds ratio [OR] 1.39 [95% confidence interval (CI): 1.25 to 1.55]}, peripheral vascular disease [OR 1.41 (95% CI: 1.29 to 1.53)], myocardial infarction [1.43 (95% CI: 1.25 to 1.63)], heart failure [OR 2.23 (95% CI: 1.99 to 2.49)], and atrial fibrillation [OR 1.96 (95% CI: 1.64 to 2.33)]. In conclusion, in the context of the inflammatory milieu that accompanies HIV infection, RDW remains a powerful marker of cardiovascular disease.

Red blood cell distribution width and myocardial scar burden in coronary artery disease

INTRODUCTION

Red blood cell distribution width (RDW) is a novel independent marker of cardiovascular disease including heart failure, coronary artery disease and myocardial ischaemia. The aim of the study was to investigate a possible relationship between RDW and myocardial scar burden, as assessed by a MIBI viability scan. A secondary objective was to assess whether there is an association between RDW and left ventricular ejection fraction (LVEF).

METHODS

The study comprised 123 subjects with ischaemic heart disease who underwent a myocardial viability scan between June 2008 and July 2014. Haemoglobin, mean corpuscular volume, RDW, platelet count, mean platelet volume (MPV), estimated glomerular filtration rate, fasting blood glucose, liver and lipid profiles were evaluated for all patients. The extent of myocardial scarring and LVEF were noted. Data were analysed using IBM SPSS Statistics 22.0. Univariate followed by multivariate analyses were performed to assess for independent predictors of myocardial scarring and LVEF, respectively.

RESULTS

The mean age of the study population was 63.5 years; most of the subjects were men. The median LVEF was 31% and median percentage of myocardial scarring was 8.7%. Multivariate analyses revealed that RDW, HDL-cholesterol and alanine transaminase were independent predictors of myocardial scarring while RDW, MPV, LDL-cholesterol and gamma-glutamyl transpeptidase were independent predictors of LVEF.

CONCLUSIONS

Increased RDW is an independent predictor both of myocardial scar burden and of impaired left ventricular function in subjects with coronary artery disease.

Can whole-blood parameters be used in follow-up of children with rheumatic valvular heart disease?

OBJECTIVES

The aim of the present study was to investigate the relationships between red blood cell distribution width, platelet distribution width, and mean platelet volume and the presence and severity of valvular involvement in patients with rheumatic heart disease.

METHODS

Between April, 2012 and December, 2015, 151 patients who were admitted to the Pediatric Cardiology Unit with diagnosis of rheumatic heart disease and 148 healthy children were included to our study. Transthoracic echocardiography for all children was performed, and the values of red blood cell distribution width, platelet distribution width, and mean platelet volume, besides other blood count parameters, erythrocyte sedimentation rate, and C-reactive protein levels were recorded.

RESULTS

Red blood cell distribution width, platelet distribution width, mean platelet volume, and C-reactive protein levels were significantly higher in patients with rheumatic heart disease when compared with healthy controls (p0.05).

CONCLUSION

This is the first study in children with rheumatic heart disease that demonstrated significantly increased red blood cell distribution width, platelet distribution width, and mean platelet volume levels, as well as evaluated all three parameters together. Furthermore, red blood cell distribution width values in the chronical period of acute rheumatic fever, due to the positive correlation with the other chronic inflammatory markers, may help make the diagnosis in children.

Red blood cell distribution width predicts long term cardiovascular event after on-pump beating coronary artery bypass grafting

Background

Reports investigating the predictive value of red cell distribution width (RDW) on major cardiac and cardiovascular event (MACCE) following coronary artery bypass grafting (CABG) have major limitations, including lack of elimination of common factors affecting RDW levels, such as anemia. The purpose of this study is to identify the real effect of higher RDW level, free from the other factors, on MACCE following CABG.

Methods

Data of 500 consecutive, non-anemic patients (77.2 % male and mean age 63.05 ± 9.24) undergoing ONBHCAB between January 2007 and January 2010, were analyzed retrospectively.

Results

Overall MACCE was 7.8 % of all cases. Mean follow-up was 66.5 ± 9.96 months. In multivariate Cox regression analysis, RDW (P = 0.022) remained the only independent predictor of MACCE and the ROC analyze revealed an RDW cut-off value of 13.95 % predicting MACCE. Therefore, patients were grouped on this cut-off value. There were 238 patients in the lower RDW group (Group 1) and 262 patients in the higher RDW group (Group 2). Kaplan–Meier survival analysis of freedom from MACCE revealed significantly lower event free survival in Group 2 (P < 0.001 by the log-rank test). Group 2 showed a higher MACCE incidence in 1 year (P = 0.030), in 3 years (P < 0.001) and in 6 years (P < 0.001). The long-term follow-up was similar regarding noncardiovascular mortality.

Conclusion

An RDW level greater than 13.95 % in hospital admission is independently associated with an increased incidence of MACCE after CABG. Physicians should be more aggressive in the management of these patients.

Role of red blood cell distribution in predicting drug-eluting stent restenosis in patients with stable angina pectoris after coronary stenting

BACKGROUND

It has been reported that increased red blood cell distribution width (RDW) predicts adverse events in cardiovascular disease and in patients undergoing percutaneous coronary intervention. However, the role of serum RDW levels in drug-eluting stent (DES) restenosis remains unclear. We aimed to investigate the relationship between serum RDW levels and in-stent restenosis (ISR) after coronary stenting with DES in stable angina pectoris (SAP) patients.

MATERIALS AND METHODS

A total of 293 consecutive chronic SAP patients with coronary DES implantation were enrolled in this study. The ISR was analyzed by coronary angiography analysis at a mean follow-up of 8 months. According to whether ISR was detected, patients were divided into two groups: the ISR group (n=45) and the non-ISR group (n=247). Serum RDW was assessed both at admission and at the 8-month follow-up in all patients. Standard medication was continued throughout the investigation period.

RESULTS

Baseline characteristics of the two groups were similar. Patients in the ISR group had significantly higher RDW levels compared with patients in the non-ISR group both at admission and at follow-up (P<0.01, respectively). Furthermore, the ISR group had significantly longer stent length and lower stent diameter compared with the non-ISR group (P<0.01, respectively). In a multivariate analysis, diabetes mellitus, current smoking, RDW levels, C-reactive protein levels, stent length, and stent diameter were associated independently with ISR.

CONCLUSION

Serum RDW level may independently predict ISR at both admission and follow-up in SAP patients with coronary DES implantation, which indicates that a chronic inflammatory response might be involved in the pathogenesis of ISR.

High aortic pulse-wave velocity may be responsible for elevated red blood cell distribution width in overweight and obese people: a community-based, cross-sectional study

Background:

Obesity and overweight are risk factors for atherosclerosis. Red blood cell distribution width (RDW) is associated with subclinical cardiac diseases. The aim of this study was to investigate the association between RDW and aortic stiffness in overweight or obese subjects.

Methods:

A total of 101 overweight or obese subjects without overt cardiovascular disorders, and 48 healthy controls were enrolled. RDW, aortic pulse-wave velocity (PWV) and augmentation index 75 (Aix75) were evaluated. The case subjects were divided into two sub-groups according to PWV values; ≥ 10 m/s in group I, and < 10 m/s in group II. Bivariate correlation and multiple regression analyses (stepwise) were performed.

Results

RDW and PWV were considerably increased in the case groups compared with the controls. RDW was significantly increased in group I compared with group II and the controls [median 12.0 m/s, interquartile range (IQR): 10.5–17.5; median 11.7 m/s, IQR: 10.2–14.2, and median 11.4 m/s, IQR: 9.6–15.5, p < 0.05, respectively]. Resting heart rate and age were higher in group I than group II (81 ± 11 vs 74 ± 12 beats/min and 41 ± 120 vs 36 ± 9 years, respectively, p < 0.05). Regression analyses revealed that while log-RDW, age and resting heart rate were independent predictors for aortic PWV, log-RDW was the most important predictor in the final model.

Conclusions:

RDW, resting heart rate and age independently predicted arterial stiffness, and RDW may be useful to provide an early recognition of subclinical atherosclerosis in overweight and obese individuals.

Red cell distribution width is a predictor of ST resolution and clinical outcome following thrombolysis in acute ST elevation myocardial infarction

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.

Red cell distribution width and mortality in carotid atherosclerosis

BACKGROUND

Red cell distribution width (RDW) is associated with morbidity and mortality in chronic cardiac disease. The aim of the present study was to investigate the role of RDW as a predictor of adverse outcome in patients with carotid atherosclerosis.

MATERIALS AND METHODS

We prospectively studied 1065 of 1286 consecutive patients with neurological asymptomatic carotid artery stenosis as assessed by duplex Doppler sonography. The study end points were all-cause mortality and cardiovascular mortality respectively.

RESULTS

During a median follow-up time of 6·2 years (interquartile range 5·9-6·6), corresponding to 5551 overall person-years, 275 patients (25·8%) died. Of them, 182 patients (66·2%) died due to cardiovascular causes. RDW was significantly associated with adverse outcome. In a continuous multivariate Cox regression analysis, the adjusted hazard ratio for each per cent increase in RDW was 1·39 (95% CI 1·27-1·53; P < 0·001) for all-cause and 1·43 (95% CI 1·28-1·60; P < 0·001) for cardiovascular mortality respectively. Kaplan-Meier estimates showed a gradual relationship between increasing quartiles of RDW and death (log rank P < 0·001). Adjusted hazard ratios for all-cause death ranged from 0·89 to 1·94 for the highest vs. the lowest quartile (P < 0·001 for trend) and for cardiovascular death from 1·08 to 2·34 for the highest vs. the lowest quartile (P < 0·001 for trend) respectively.

CONCLUSIONS

Red cell distribution width was significantly and independently associated with all-cause and cardiovascular death in patients with asymptomatic carotid atherosclerosis.

Red blood cell distribution width and cardiovascular diseases

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.

The prognostic value of admission red cell distribution width-to-platelet ratio in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

OBJECTIVE

Red cell distribution width (RDW) is a measure of variation in the size of circulating red blood cells. Recent studies have reported a strong independent relation between elevated RDW and short- and long-term prognosis in various disorders. The aim of the present study was to investigate the relationship between admission RDW-to-platelet ratio (RPR) and in-hospital and long-term prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).

METHODS

A total of 470 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study. The patients were divided into two groups based on their admission RPR: high (>0.061) RPR group and low (≤0.061) RPR group. The patients were followed for adverse clinical outcomes in-hospital and for up to one year after discharge.

RESULTS

In-hospital cardiovascular mortality, major adverse cardiovascular events (MACE), advanced heart failure and cardiogenic shock were significantly higher in the high RPR group (p<0.05). All-cause and cardiovascular mortality, MACE, fatal reinfarction, advanced heart failure, and rehospitalization for cardiac cause were more frequent in the high RPR group in one-year follow-up (p<0.05). High RPR was found to be a significant independent predictor of one-year cardiovascular mortality in multivariate analysis (p=0.003, OR: 3.106, 95% CI: 1.456-6.623).

CONCLUSION

RPR is an inexpensive and readily available biomarker that provides an additional level of risk stratification beyond that provided by conventional risk parameters in predicting long-term MACE and cardiovascular mortality in STEMI.

The Prognostic Role of Red Blood Cell Distribution Width in Coronary Artery Disease: A Review of the Pathophysiology

Red blood cell distribution width (RDW) is a measure of red blood cell volume variations (anisocytosis) and is reported as part of a standard complete blood count. In recent years, numerous studies have noted the importance of RDW as a predictor of poor clinical outcomes in the settings of various diseases, including coronary artery disease (CAD). In this paper, we discuss the prognostic value of RDW in CAD and describe the pathophysiological connection between RDW and acute coronary syndrome. In our opinion, the negative prognostic effects of elevated RDW levels may be attributed to the adverse effects of independent risk factors such as inflammation, oxidative stress, and vitamin D₃ and iron deficiency on bone marrow function (erythropoiesis). Elevated RDW values may reflect the intensity of these phenomena and their unfavorable impacts on bone marrow erythropoiesis. Furthermore, decreased red blood cell deformability among patients with higher RDW values impairs blood flow through the microcirculation, resulting in the diminution of oxygen supply at the tissue level, particularly among patients suffering from myocardial infarction treated with urgent revascularization.

Red Blood Cell Distribution Width is Independently Correlated With Diurnal QTc Variation in Patients With Coronary Heart Disease

To investigate the relationship between red blood cell distribution width (RDW) and diurnal corrected QT (QTc) variation in patients with coronary heart disease. This retrospective study included 203 patients who underwent coronary angiography between February 2013 and June 2014. RDW values and dynamic electrocardiography (Holter) results were collected to investigate the relationship between RDW and diurnal QTc variation. Patients were separated into three groups (A, B, and C) by binning their RDW values in an ascending order. RDW values, coronary artery scores and diurnal QTc variations were significantly different among these groups (P < 0.05). While coronary artery scores gradually rose with increased RDW, diurnal QTc variation decreased. Pearson's correlation analysis was applied to control for confounding factors, and multiple correlation analysis showed that coronary artery score was positively correlated with RDW (r = 0.130, P = 0.020), while it was not correlated with the diurnal QTc variation (r = -0.226, P = 0.681). RDW was negatively correlated with diurnal QTc variation (r = -0.197, P = 0.035). RDW is independently associated with diurnal QTc variation in patients with coronary heart disease.

Association between red cell distribution width and the risk of heart events in patients with coronary artery disease

Red cell distribution width (RDW) has been found to be a novel prognostic biomarker in patients with coronary artery disease (CAD); however, the association between RDW and the risk of heart events in patients with CAD is yet to be fully elucidated. Thus, the aim of the present study was to determine whether an elevated RDW was associated with the Framingham risk score (FRS) in patients with CAD. Data were retrospectively collected from Affiliated Dongyang Hospital of Wenzhou Medical University (Dongyang, China). The patients had undergone a coronary angiography and their clinical data were integrated. The patients (male, 260; female, 132) were divided into two groups based on the results of the coronary angiography, namely the CAD (n=283) and control groups (n=109). The FRS was calculated for all the subjects, and complete blood count testing with biochemical measurements was performed. The mean RDW level was 13.7±1.8% in the CAD group and 13.1±1.0% in the control group, while the mean FRS was 9.0±4.9 in the CAD group and 6.4±3.9 in the control group. The RDW and FRS were significantly higher in the CAD group compared with the control group (P<0.001). No statistically significant differences were observed between the groups with regard to the hematocrit, mean corpuscular volume, platelets, glucose, urea, albumin, aspartate aminotransferase, total cholesterol, triglycerides (TG), high-density lipoprotein cholesterol, low-density lipoprotein cholesterol and N-terminal pro-brain natriuretic peptide (P>0.05). The RDW was shown to significantly correlate with the red blood cell (RBC) count (r=-0.133, P=0.029), hemoglobin level (r=-0.207, P=0.001) and TG level (r=0.226, P<0.001) within the laboratory parameters, as well as the FRS (r=0.206, P<0.001). In the stepwise multivariate linear regression, which included the RBC count, hemoglobin level, TG level and RDW, the FRS was predicted by hemoglobin (r²=0.034, P=0.001), TG (r²=0.059, P<0.001) and RDW (r²=0.030, P=0.003) parameters. Therefore, a novel association was revealed between higher levels of RDW and an elevated FRS in patients with CAD, which raises the possibility that a simple marker, RDW, may be associated with an increased risk of heart events in CAD patients.

Red cell distribution width and carotid atherosclerosis progression. The Tromsø Study

Red cell distribution width (RDW), a measure of the size variability of circulating erythrocytes, is associated with cardiovascular morbidity and mortality. We aimed to investigate whether RDW was associated with progression of atherosclerotic plaques in subjects recruited from the general population. Baseline characteristics, including RDW, were collected from 4677 participants in the fourth survey of the Tromsø Study conducted in 1994/95. Prevalence of carotid plaques and total plaque area (TPA) were assessed by ultrasonographic imaging at baseline and after seven years of follow-up. Generalised linear models were used to analyse change in TPA across tertiles of RDW. Change in TPA was significantly higher across tertiles of RDW in crude analysis and in multivariable analysis adjusted for cardiovascular risk factors. The mean change in TPA increased from 5.6 mm² (4.9-6.4) in tertile 1 (RDW ≤ 12.6 %) to 6.7 mm² (5.9-7.6) in tertile 3 (RDW ≥ 13.3) in multivariable analysis adjusted for body mass index, total cholesterol, HDL cholesterol, systolic blood pressure, self-reported diabetes, smoking status, platelet count, white blood cell count, and hs-CRP levels (p for trend 0.003). A 1 % increase in RDW was associated with 0.6 mm² (0.1-1.2) increase in TPA in multivariable analysis (p=0.03). RDW was associated with progression of atherosclerosis after adjustments for traditional atherosclerotic risk factors. Our findings suggest that the link between RDW and cardiovascular morbidity and mortality may be explained by atherosclerosis.

Is red cell distribution width a marker for the presence and poor prognosis of cardiovascular disease?

Red cell distribution width (RDW) is an indices heterogeneity of cell size in the peripheral blood and has been shown to be an independent correlate of adverse outcomes in healthy subjects and in some cardiac conditions. Additionally, RDW is associated with both the presence and the complexity of vascular disease. In this review we investigate the importance of RDW in vascular disease in the light of recent information.

Association of red blood cell distribution width levels with severity of coronary artery disease in patients with non-ST elevation myocardial infarction

OBJECTIVES

The aim of this study was to evaluate the association of the levels of red blood cell distribution width (RDW) with the severity of atherosclerosis and to determine whether or not the RDW level on admission is an independent predictor of all-cause mortality in patients with non-ST elevation myocardial infarction (NSTEMI).

MATERIALS AND METHODS

A total of 335 consecutive patients with NSTEMI were enrolled in this study. The patients were divided into high (n = 105) and low (n = 230) SYNTAX groups. The high SYNTAX group was defined as patients with a value in the third tertile (SYNTAX score, SXscore ≥12), while the low SYNTAX group was defined as those with a value in the lower 2 tertiles (SXscore <12). The high RDW group (n = 152) was defined as patients with RDW >14.25% and the low RDW group (n = 183) as those with RDW ≤14.25%. All-cause mortality was followed up to 38 months.

RESULTS

The mean follow-up period was 18 ± 11 months. The RDW levels of patients were significantly higher in the high SYNTAX group than in the low SYNTAX group (15.2 ± 1.8 vs. 14.2 ± 1.2, p < 0.001). Pearson's coefficients were used to determine the degree of association between RDW levels and SXscore and also between RDW levels and high-sensitivity C-reactive protein. There was a significant correlation between RDW levels and SXscore (r = 0.460, p < 0.001). Also, there was a significant correlation between RDW levels and high-sensitivity C-reactive protein (r = 0.180, p = 0.001). All-cause mortality rate was not significantly different between the high and low RDW groups (log-rank, p = 0.621).

CONCLUSION

RDW levels were independently associated with high SXscore but were not associated with long-term mortality in NSTEMI patients.

Relationship between red cell distribution width and long-term mortality in patients with non-ST elevation acute coronary syndrome

Objective:

Red cell distribution width (RDW) has been reported to be a predictor of cardiac events in coronary artery disease (CAD). Here, we hypothesized that RDW level on admission would be predictive of adverse outcomes in non-ST elevation acute coronary syndrome (NST-ACS).

Methods:

In total, 202 patients with NST-ACS (159 males and 43 females) were retrospectively analyzed. The patients were divided into two groups based on the 50th percentile of admission RDW levels. A high RDW group (n=100) was defined as those patients having RDW levels of >14.0. The relationship between RDW and primary endpoint (cardiovascular death), secondary endpoints [(reinfarction, repeat target vessel revascularization-percutaneous/surgical)], and major adverse cardiac events (MACE) were assessed. The median follow-up time was 18 (13-24) months.

Results:

The patients in the high RDW group were older (62.9 vs. 57.5, p=0.001). Multivessel disease, low-density lipoprotein, creatinine, platelet, CK-MB, troponin I, and RDW were higher (p=0.047, p=0.003, p=0.012, p=0.012, p=0.017, p<0.001, respectively), and gender (male/female), ejection fraction, and hemoglobin levels were lower (p=0.021, p=0.04, p=0.016, respectively) in the high RDW group. Cardiovascular death and MACE were higher in the high RDW group (16% vs. 4.9%, p=0.01, 52% vs. 31.4%, p=0.003, respectively). By multiple regression analysis in 202 patients, age >65 and RDW >14.0% on admission were found to be powerful independent predictors of cardiovascular mortality (OR: 4.5, 95% CI: 1.5-13.1, p=0.005, OR: 3.0, 95% CI: 1.0-8.9, p=0.039, respectively).

Conclusion:

A high RDW level on admission is associated with increased long-term mortality in patients with NST-ACS.

The importance of laboratory parameters in patients with obstructive sleep apnea syndrome

Platelet activation and inflammation are the related mechanisms of pathogenesis in obstructive sleep apnea syndrome (OSAS). Mean platelet volume (MPV) and platelet distribution width (PDW) are the markers of platelet activation. C-reactive protein (CRP) and red cell distribution width (RDW) in relation to the inflammation in OSAS might be increased. We aimed to investigate the correlation of the MPV, PDW, and RDW levels with the severity of OSAS. We included 98 patients with suspected OSAS, evaluated by polysomnography. According to their apnea-hypopnea index (AHI), patients were divided into group A (n = 20; 20.4%) with AHI below 5/h; group B (n = 15; 15.3%) with AHI 5-14.9/h; group C (n = 26; 26.5%) with AHI 15-29.9/h; and group D (n = 37; 37.8%) with AHI ≥30/h. Hemoglobin, MPV, PDW, and RDW were measured using an automated blood cell counter. BMI and age showed a statistically significant and gradual increase in AHI groups. Hemoglobin, platelet, CRP, MPV, and RDW values did not differ between AHI groups. PDW was significantly higher in group D (mean value 14.4 ± 1.8) than in group A (13.2 ± 0.5) (P < 0.001). Epworth sleepiness scale was significantly higher in group D (9.9 ± 5.5) than in group A (5.6 ± 3.5), B (9.2 ± 3.6) and C (6.6 ± 3.8) (P = 0.005). When the four groups were compared, group D had the lowest minimum SpO2 value [group A (89.4 ± 3.0), B (86.7 ± 4.2), C (81.2 ± 6.4), and D (68.2 ± 13.0)]. There was a statistically significant correlation between AHI and age (r = 0.35, P < 0.001), BMI (r = 0.31, P = 0.003), PDW (r = 0.28, P = 0.006), and Epworth sleepiness scale (r = 0.29, P = 0.007). However, AHI was not correlated with CRP, MPV, and RDW. PDW is higher in severe OSAS and is correlated with different parameters of breathing function during sleep. The severity of OSAS was not correlated with CRP, MPV, and RDW. These findings show an evidence for platelet activation in OSAS and suggest that PDW might be related markers of OSAS severity.

Relationship Between Red Cell Distribution Width and the GRACE Risk Score With In-Hospital Death in Patients With Acute Coronary Syndrome

The aim of this study was to evaluate the relationship between red cell distribution width (RDW) and Global Registry of Acute Coronary Events (GRACE) risk score in patients with unstable angina pectoris (UAP) and non-ST elevation myocardial infarction (NSTEMI). We retrospectively enrolled 193 patients with UAP/NSTEMI (mean age 63.6 ± 12.6 years; men 57%) in this study. Higher RDW values were associated with increased in-hospital mortality (P = .001). There is a significant correlation between RDW and GRACE score (P < .001). In multivariate logistic regression analysis, RDW was found to be an independent predictor of high GRACE score (odds ratio: 1.513, 95% confidence interval: 1.116-2.051, P = .008). A cutoff value of >15.74 for RDW predicted high GRACE score, with a 64% sensitivity and 65% specificity. Our study results demonstrated that high RDW was an independent predictor of high GRACE score, and it is associated with in-hospital mortality in UAP/NSTEMI.

Relation of red cell distribution width with CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation

BACKGROUND

Red cell distribution width (RDW) has been shown to be helpful in predicting adverse long-term events in patients with cardiovascular diseases. However, to date, no study has been conducted on the relationship between RDW and thromboembolism risk in atrial fibrillation (AF). Therefore, we aimed to investigate the relationship between RDW and CHA2DS2-VASc score used for the evaluation of thromboembolism risk in patients with AF.

METHODS

The study population consisted of 320 patients with AF. We calculated CHA2DS2-VASc risk score for each patient and baseline hemoglobin, white blood cell, RDW, mean platelet volume, platelet counts, estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), and left atrial volume index (LAVi) were measured.

RESULTS

High CHA2DS2-VASc score group had higher RDW, lower LVEF, higher LAVi, and lower eGFR values when compared to the low CHA2DS2-VASc score group. The multivariate logistic regression analysis performed to predict high CHA2DS2-VASc scores revealed that RDW eGFR, LVEF, and LAVi were independent predictors. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.59-0.71, P < .001) to predict high CHA2DS2-VASc score.

CONCLUSION

Our study results indicate that RDW values are significantly correlated with CHA2DS2-VASc score in nonanemic patients with AF, while also being independent predictor of high CHA2DS2-VASc score.

Relation of coronary collateral circulation with red cell distribution width in patients with non-ST elevation myocardial infarction

OBJECTIVES

We aimed to investigate the relationship between red cell distribution width (RDW) value and coronary collateral circulation (CCC) in patients with non-ST elevation myocardial infarction (NSTEMI).

METHODS

The study population consisted of 322 consecutive patients with NSTEMI. The patients were classified into impaired CCC (group 1, Rentrop grades 0-1) or good CCC (group 2, Rentrop grades 2-3). Baseline RDW was measured as part of the automated complete blood count.

RESULTS

The RDW values were significantly higher in patients with impaired CCC than in those with good CCC (17.2 ± 2.3 vs 14.5 ± 2.5, P < .001). In multivariate logistic regression analysis, RDW (odds ratio: 1.52, 95% confidence interval: 1.30-1.78, P < .001), baseline creatine kinase MB (CK-MB), and absence of preinfarction angina were found to be the independent predictors of impaired CCC. In receiver-operating characteristic curve analysis, the RDW value >15.5 yielded an area under curve value of 0.783, with 77% sensitivity and 73% specificity.

CONCLUSIONS

Our study results demonstrated that, high RDW, high CK-MB, and absence of preinfarction angina were found to be independent predictors of impaired CCC.

Red blood cell distribution width in 'non-dippers' versus 'dippers'

OBJECTIVES

Because both high red cell distribution width (RDW) and non-dipping hypertension are closely related to adverse cardiovascular outcomes and higher inflammatory status, we aimed to investigate whether there is any relationship between RDW and dipping/non-dipping hypertension status.

METHODS

The present study involved 123 hypertensive patients and 65 age- and gender-matched healthy, normotensive subjects. Hypertensive patients were divided into two groups: 56 dipper patients (20 males, mean age 51.9 ± 15.3 years) and 67 non-dipper patients (27 males, mean age 55.6 ± 15.0 years). If the systolic daytime blood pressure (BP) of the patients decreased by at least 10% during the nighttime, these subjects were 'dippers', and all other subjects were 'non-dippers'.

RESULTS

Both dipper patients and non-dipper patients had higher levels of RDW compared to normotensives (13.5 ± 0.89 and 14.1 ± 1.33 vs. 13.0 ± 1.42%, p = 0.027 and p < 0.001, respectively). Also RDW values in non-dippers were statistically higher compared to those in dippers (p = 0.008). Although there were negative correlations between RDW values and nocturnal systolic BP fall (p = 0.027, r = -0.199) and diastolic BP fall (p = 0.383, r = -0.079) in all hypertensive patients, these correlations did not reach a statistically significant level.

CONCLUSION

Our study demonstrates that non-dippers have high RDW levels compared to both dippers and controls.

Relation Between Red Cell Distribution Width and Severity of Coronary Artery Disease in Patients With Acute Myocardial Infarction

Increased red blood cell distribution width (RDW) has been associated with adverse outcomes in acute myocardial infarction (AMI). We evaluated the relationship between RDW and severity of coronary artery disease (CAD) in patients with AMI. We analyzed the relation between RDW and angiographic severity of CAD. Patients (n = 580) with elevated Syntax scores (SSs >32) had higher RDW values (15.1% ± 1.7% vs 14.1 ± 1.7%, P < .001). The SS was positively correlated with RDW level ( r = .252, P < .001) and neutrophil/lymphocyte (N/L) ratio ( r = .178, P < .001). There was a mild significant association between RDW level and N/L ratio ( r = .106, P = .033). In the multiple logistic regression analysis, RDW (odds ratio = 1.165, 95% confidence interval 1.02-1.32, P = .021) remained a significant predictor for the severity of CAD. Red blood cell distribution width, an inexpensive and easily measurable laboratory variable, is independently associated with the severity of CAD in patients with AMI.

Relation of red cell distribution width with presence and severity of coronary artery ectasia

Red cell distribution width (RDW) is an index that has been shown to be an independent correlate of adverse outcomes in some cardiac conditions. Isolated coronary artery ectasia (CAE) is an abnormality of the coronary anatomy and can cause ischemia. We hypothesized that increased RDW would be associated with isolated CAE because both are associated with inflammation. In this study, 2345 patients who received coronary angiography were retrospectively evaluated. After exclusion, 75 patients with isolated CAE and 96 consecutive patients with normal coronary were included in the study. The severity of isolated CAE was determined according to the Markis classification. Baseline RDW was measured as part of the automated complete blood count. Red cell distribution width was observed to be an independent predictor of both presence and severity of isolated CAE. In conclusion, RDW is associated with both the presence and severity of isolated CAE.