Abstract
Red cell distribution width (RDW) and neutrophil/lymphocyte ratio (NLR) have been found to be associated with cardiovascular diseases. Only a few trials have investigated the correlation of these parameters with postoperative atrial fibrillation (AF). However, the correlation of these parameters in non-valvular AF is still unclear. We retrospectively analyzed consecutive AF patients from medical records and included 117 non-valvular AF patients (103 paroxysmal and 14 chronic AF). All subjects underwent physical examination and echocardiographic imaging. Complete blood counts (CBCs) were analyzed for hemoglobin, RDW, neutrophil and lymphocyte counts as well as mean corpuscular volume. Results of CBC tests within the previous year were also included and the averages were used. The demographic and echocardiographic properties of non-valvular AF group were comparable to the control group except for left atrial volumes which were increased in AF (median 33.1, IQR 26.3–41.1 cm3 vs. median 26.4, IQR 24.2–28.9 cm3; p = 0.01). RDW levels were significantly higher in the AF group (median 13.4 %, IQR 12.9–14.1 %) compared to the control (median 12.6 %, IQR 12.0–13.1 %; p = 0.01). NLR was not statistically different in the AF group and the controls (2.04 ± 0.94 vs. 1.93 ± 0.64, respectively; p = 0.32). Hs-CRP levels were higher in the AF group compared to the controls (median 0.84, IQR 0.30–1.43 mg/L vs. median 0.29, IQR 0.18–0.50 mg/L, respectively; p = 0.01). Multivariate logistic regression analysis revealed RDW (OR 4.18, 95 % CI 2.15–8.15; p = 0.01), hs-CRP (OR 3.76, 95 % CI 1.43–9.89; p = 0.01) and left atrial volume (OR 1.31, 95 % CI 1.06–1.21; p = 0.01) as the independent markers of non-valvular AF. Multivariate linear regression analysis revealed that hemoglobin levels (standardized β coefficient = −0.252; p = 0.01) and the presence of AF (standardized β coefficient = 0.336; p = 0.01) were the independent correlates of RDW levels. Elevated RDW levels, not NLR, may be an independent risk marker for non-valvular AF.
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Felker GM, Allen LA, Pocock SJ et al (2007) Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 50:40–47
Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L (2009) Prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 158:659–666
van Kimmenade RR, Mohammed AA, Uthamalingam S, van der Meer P, Felker GM, Januzzi JL Jr (2010) Red blood cell distribution width and 1 year mortality in acute heart failure. Eur J Heart Fail 12:129–136
Allen LA, Felker GM, Mehra MR et al (2010) Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail 16:230–238
Tonelli M, Sacks F, Arnold M et al (2008) Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation 117:163–168
Ani C, Ovbiagele B (2009) Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 277:103–108
Dabbah S, Hammerman H, Markiewicz W, Aronson D (2010) Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol 105:312–317
Tamhane UU, Aneja S, Montgomery D, Rogers EK, Eagle KA, Gurm HS (2008) Association between admission neutrophil to lymphocyte ratio and outcomes in patients with acute coronary syndrome. Am J Cardiol 102:653–657
Núñez J, Núñez E, Bodí V et al (2008) Usefulness of the neutrophil to lymphocyte ratio in predicting long-term mortality in ST segment elevation myocardial infarction. Am J Cardiol 101:747–752
Duffy BK, Gurm HS, Rajagopal V, Gupta R, Ellis SG, Bhatt DL (2006) Usefulness of an elevated neutrophil to lymphocyte ratio in predicting long-term mortality after percutaneous coronary intervention. Am J Cardiol 97:993–996
Ertas G, Aydin C, Sönmez O et al (2012) Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting. Scand Cardiovasc J Oct 18 [Epub]
Gibson PH, Cuthbertson BH, Croal BL et al (2010) Usefulness of neutrophil/lymphocyte ratio as predictor of new-onset atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 105:186–191
Sanfilippo A, Abascal V, Sheehan M, Oertel L, Harrigan P, Hughes R, Weyman A (1990) Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 82:792–797
Frustaci A, Caldarulo M, Buffon A, Bellocci F, Fenici R, Melina D et al (1991) Cardiac biopsy in patients with “primary” atrial fibrillation. Histologic evidence of occult myocardial diseases. Chest 100:303–306
Ellinor PT, Low A, Patton KK, Shea MA, MacRae CA (2006) C-Reactive protein in lone atrial fibrillation. Am J Cardiol 97(9):1346–1350
Schnabel RB, Larson MG, Yamamoto JF, Kathiresan S, Rong J, Levy Det et al (2009) Relation of multiple inflammatory biomarkers to incident atrial fibrillation. Am J Cardiol 104(1):92–96
Pascual-Figal DA, Bonaque JC, Redondo B et al (2009) Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail 11:840–846
Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC (2009) Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 133:628–632
Perlstein TS, Weuve J, Pfeffer MA, Beckman JA (2009) Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med 169:588–594
Patel KV, Semba RD, Ferrucci L, Newman AB, Fried LP, Wallace RB et al (2010) Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci 65(3):258–265
Horne BD, May HT, Muhlestein JB et al (2009) Exceptional predictive ability for all-cause mortality by risk scores computed from common clinical laboratory tests. Am J Med 122:550–558
Agarwal Shikhar (2012) Red cell distribution width, inflammatory markers and cardiorespiratory fitness: results from the National Health and Nutrition Examination Survey. Indian Heart J 64(4):380–387
Lappé JM, Horne BD, Shah SH et al (2011) Red cell distribution width, C-reactive protein, the complete blood count, and mortality in patients with coronary disease and a normal comparison population. Clin Chim Acta 412(23–24):2094–2099
Kyne L, Hausdorff JM, Knight E, Dukas L, Azhar G, Wei JY (2000) Neutrophilia and congestive heart failure after acute myocardial infarction. Am Heart J 139:94–100
Kiefer CR, Snyder LM (2000) Oxidation and erythrocyte senescence. Curr Opin Hematol 7:113–116
Weiss G, Goodnough LT (2005) Anemia of chronic disease. N Engl J Med 352:1011–1023
Grant BJ, Kudalkar DP, Muti P, McCann SE, Trevisan M, Freudenheim JL et al (2003) Relation between lung function and RBC distribution width in a population-based study. Chest 124:494–500
Akpek M, Kaya MG, Lam YY et al (2012) Relation of neutrophil/lymphocyte ratio to coronary flow to in-hospital major adverse cardiac events in patients with ST-elevated myocardial infarction undergoing primary coronary intervention. Am J Cardiol 110(5):621–627
Arıbaş A, Akıllı H, Gül EE et al (2012) Neutrophil/lymphocyte ratio predict recurrence after electrical cardioversion in non-valvular atrial fibrillation? Anadolu Kardiyol Derg Dec 7.doi: 10.5152/akd.2013.036 [epub]
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Güngör, B., Özcan, K.S., Erdinler, İ. et al. Elevated levels of RDW is associated with non-valvular atrial fibrillation. J Thromb Thrombolysis 37, 404–410 (2014). https://doi.org/10.1007/s11239-013-0957-1
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DOI: https://doi.org/10.1007/s11239-013-0957-1