Study Of The Relationship Between Red Blood Cell Distribution Width And Cardiac Function In Patients With Chronic Heart Failure

Objective:To analyze the relationship between Red blood cell distribution width（RDW）and cardiac hemodynamics in patients with Chronic heart failure（CHF）.To evaluate the clinical value of RDW in evaluating cardiac function in patients with CHF,and to explore the factors affecting RDW in patients with CHF.Methods:136 patients with CHF who were hospitalized in the department of Cardiovascular Medicine of Fenyang Hospital from September 2016 to May 2018 were divided into three groups:low RDW group（<13.2%,43 cases）,medium RDW group（13.2%-14.5%,47cases）and high RDW group（>14.5%,46 cases）.The clinical data of the three groups were collected and the blood parameters,cardiac hemodynamic parameters and the activity of Na⁺-K⁺-ATPase（Na⁺,K⁺-ATPenzyme）,Ca²⁺-Mg²⁺-ATPase(Ca²⁺,Mg²⁺-ATPenzyme)in erythrocyte membranes were compared.The correlation between RDW and cardiac hemodynamic parameters was detected by Pearson analysis.The factors affecting the change of RDW were analyzed by multiple linear regression method.Results:1.Comparison of hemodynamic parameters among different RDW groupsThere were significant differences in cardiac output（CO）,cardiac index（CI）,left ventricle ejection fraction（LVEF）,the index of contractile（IC）,cardiac work（CW）and cardiac work index（CWI）among the three groups（P<0.05）.Compared with the low RDW group,the high RDW group was found a significantly decreased in CO,CI,LVEF,IC,CW and CWI（P<0.05）.Compared with the middle RDW group,the high RDW group was found a significantly decreased in CO and LVEF（P<0.05）.2.Correlation analysis between RDW and Cardiac hemodynamic parametersRDW in CHF patients was negatively correlated with LVEF（r=-0.3551,P<0.001）,SV（r=-0.1841,P=0.032）,CO（r=-0.2640,P=0.002）,CI（r=-0.2763,P=0.001）,AMPC（r=-0.2437,P=0.004）,IC（r=-0.2669,P=0.002）,HI（r=-0.2213,P=0.009）,SW（r=-0.1987,P=0.020）,CW（r=-0.2975,P=0.001）and CWI（r=-0.3156,P=0.001）.However there was a positive correlation between RDW and AMPO（r=0.2000,P=0.020）,AMPO/AMPC（r=0.2860,P<0.001）.3.Comparison of the blood parameters and the activity of Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-ATPase in erythrocyte membranes among different RDW groupsThere were significant differences in hemoglobin,albumin,direct bilirubin,LogNT-proBNP（N-terminal brain natriuretic peptide）,the activity of Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-ATPase of erythrocyte membrane among the three groups（P<0.05）.Compared with the low RDW group,the high RDW group was found a significantly decreased in hemoglobin,albumin and the activity of Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-ATPase of erythrocyte membrane（P<0.05）,and a significantly increased in direct bilirubin and Log NT-proBNP.Compared with the low RDW group,the middle RDW group was found a significantly decreased in the activity of Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-ATPase of erythrocyte membrane（P<0.05）.Compared with the middle RDW group,the high RDW group was found a significantly decreased in the activity of Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-ATPase of erythrocyte membrane（P<0.05）.4.Correlation analysis of RDW with the blood parameters and the activity of Na⁺-K⁺-ATPase,Ca²⁺-Mg²⁺-ATPase of erythrocyte membraneRDW is negatively related to hemoglobin（r=0.2887,P=0.001）,albumin（r=0.2016,P=0.019）,the activity of Na⁺-K⁺-ATPase（r=0.8216,P=0.001）and Ca²⁺-Mg²⁺-ATPase（r=0.7366,P=0.001）in erythrocyte membrane,but it is positively related to LogNT-proBNP（r=0.2251,P=0.008）,glutamic-pyruvic transaminase（r=0.2477,P=0.004）,glutamic oxaloacetic transaminase（r=0.3138,P=0.001）and direct bilirubin（r=0.1919,P=0.025）.Multiple linear regression analysis showed that LVEF,albumin,direct bilirubin and the activity of Na⁺-K⁺-ATPase and Ca²⁺-Mg²⁺-ATPase in erythrocyte membrane were the factors affecting the changes of RDW in patients with CHF,which regression coeffici-ents were-0.104,-0.133,0.111,-0.577,-0.263（P<0.05）.Conclusion:1.For CHF patients,the RDW is concerned with the cardiac hemodynamics,which may have a certain clinical value for the evaluation of cardiac function.2.The change of activity of erythrocyte membrane Na⁺,K⁺-ATPase and Ca²⁺,Mg²⁺-ATPase is one of the factors affecting RDW in CHF patients.LVEF,albumin and direct bilirubin can also affect the RDW level in CHF patients.