Correlation Between Red Blood Cell Distribution Width Standard Deviation And Right Ventricular Diameter Dilated In Heart Failure With Preserved Ejection Fraction Elderly Patients

Objective:To investigate the correlation between the red blood cell distribution width standard deviation and right ventricular diameter dilated in heart failure with preserved ejection fraction elderly patients,and to study the factors influencing right ventricular diameter,so as to guide disease prevention and treatment.Methods:Clinical data of 195 elderly patients with HFp EF admitted in Jinqiu Hospital of Liaoning Province from September 2017 to April 2020 were collected,including 120patients with normal right ventricular diameter and 75 patients with dilated right ventricular diameter.Data of the two groups were collected,including basic data,such as age,sex,BMI,NYHA classification,tobacco and alcohol history,average heart rate,average arteria pressure,the history of hypertension,coronary heart disease,diabetes,atrial fibrillation and dyslipidemia etc;Laboratory data such as red blood cell count,hemoglobin,red blood cell distribution width standard deviation,NLR,D-dimer,NT-pro BNP,glutamate transaminase,serum albumin,serum creatinine,serum uric acid,high density lipoprotein cholesterol,low density lipoprotein cholesterol,sodium,potassium etc;Echocardiographic indexes,such as:early diastolic mitral valve blood flow velocity（E）,peak velocity of tricuspid regurgitation（TRV）,pulmonary artery systolic pressure（PASP）,left atrial end-diastolic diameter（LAEDd）,left ventricular end-diastolic diameter（LVEDd）,right end-diastolic diameter（RAEDd）,pulmonary artery diameter,right ventricular end-diastolic diameter（RVEDd）,left ventricular ejection fraction（LVEF）,mitral valve ring diastolic velocity（E’）,and calculate the E/E’.The differences between two groups were compared.If the continuous variables are normal distribution,T test is used for comparison between groups.Nonparametric test was used if normal distribution was not followed.Categorical variables were described as frequency（%）,and comparison between groups was made by chi-square test.Spearman correlation analysis and binary Logistic regression analysis were used for correlation performed for the correlation analysis.Receiver Operating characteristics（ROC）curve was used to determine the diagnostic value of variables prediction.Logistic regression was used to analyze the interaction between grouping factors and red blood cell distribution width standard deviation in subgroup analysis.Two-sided P<0.05 was considered statistically significant for each analysis.Results:1.Compared with normal group,right ventricular diameter dilated group patients’data,like average heart rate,ejection fraction,right ventricular end-diastolic diameter,left atrial end-diastolic diameter,the diameter of pulmonary artery,pulmonary artery systolic pressure,E/E’,TRV,AST,low density lipoprotein cholesterol,NT-pro BNP,red blood cell distribution width standard deviation,NLR,history of coronary heart disease,hypertension,atrial fibrillation,COPD,BMI,NYHA classification statistical differences（P<0.05）.There were no statistically significant differences in age,mean arterial pressure,red blood cell count,hemoglobin,albumin,creatinine,uric acid,high-density lipoprotein cholesterol,sodium,potassium,d-dimer,left ventricular end-diastolic diameter,history of diabetes,history of smoking,and history of alcohol consumption between the two groups（P>0.05）.2.There is a positive correlation between red blood cell distribution width standard deviation and right ventricular diameter（r=0.427,P=0.000）.3.After adjusting for related risk factors,multivariate Logistic regression analysis showed that RDW-SD was still the risk factor of right ventricular diameter dilated（OR=1.254,95%CI:1.108～1.396,P<0.001）.4.ROC curve analysis of the standard deviation of red blood cell distribution width predicting the increase of right ventricular diameter:AUC:0.851,sensitivity:81.3%,specificity:78.2%.5.When the RDW-SD was divided into quartile groups.With the increase of groups,the risk of right ventricular diameter dilated was gradually increased,and the risk of the second,third and fourth groups was 8.623,27.258 and 67.791 times of the first group,respectively（P<0.05）.6.After divided into groups,the comparison between red blood cell distribution width standard deviation and NT-pro BNP found that the first,second,third groups with the fourth group has a statistical difference（P<0.01）,but pairwise comparisons were made in the first,second,third groups have no statistical difference（P>0.05）.7.Age,gender,history of coronary heart disease,atrial fibrillation,hypertension,diabetes,chronic obstructive pulmonary disease,NYHA grade,overweight and RDW-SD have no interaction effects on the right ventricular diameter dilated(P_interaction>0.05).Conclusion:In heart failure with preserved ejection fraction elderly patients,the red blood cell distribution width standard deviation can has a certain predictive value in evaluating the right ventricle dilated.