The Predictive And Reference Value Of Blood Cell Distribution Width In Coronary Heart Disease And Heart Failure

The changes of the morphology and size of blood cells are associated with the occurrence, development or the prognosis of related diseases for example hematologic diseases or cardiovascular diseases. Thus, the raise of blood cell distribution width may be an indicator of risk evaluation or stratification of the diseases. Our study sought to understand the relationship between blood cell distribution width, that is red cell distribution width (RDW) and platelet distribution width or platelet size deviation width (PDW) with coronary heart disease and heart failure through retrospective study. And to preliminary study and assess the value of both indicators in predicting cardiovascular diseases and the prognosis. In the other hand, to analysis whether the indicators can provide a reference for clinical treatment in prediction and stratification of high risk patients.Objective:The change of red cell distribution width might be valuable in predicting the occurrence, development and prognosis of coronary heart disease and chronic heart failure. Our study aimed to understand is there any existence of the relationship between coronary heart disease or heart failure and red cell distribution width. Thus further explore of the possibility of red cell distribution width to serve as a reference indicator for clinical doctors to provide relevant information of in stratify high risk patients.Methods:We performed a retrospective study on 250 cases that were included due to a variety of indications for coronary angiography in our hospital start from November 2008 to December 2009. The patients were defined into 2 groups according to coronary angiography results as group CAG(-) and group CAG(+), t-test comparison were used to compare whether differences of RDW exist in between the groups. Then, the two groups were further separated according to clinical manifestations, laboratory evaluation and cardiac echocardiography, and refer to the New York Heart functional class (NYHA), patients were divided into 4 groups which are CAG(-)/NYHA I, CAG(-)/NYHA II-IV, CAG(+)/NYHA I and CAG(+)/NYHA II-IV. We used One-way analysis of variance (ANOVA) inter-group comparison to examine the association between RDW and heart failure. Furthermore, single factor analysis and multivariate linear regression analysis were use to understand the co-relationship and relationship of RDW, heart failure and other markers such as left ventricular ejection fraction, hematology parameters, biochemical parameters.Results:There has no significant difference of RDW found between CAG(-)group and CAG(+) group, which were 13.16±0.91 and 13.13±1.10 respectively (P=0.845). However higher RDW in patients with heart failure in all-cause was detected,13.55±1.08 of group CAG(-)/NYHAII-IV and 13.36±1.27 of group CAG(+)/NYHAII-IV and there are significantly statistical difference compare to group CAG(-)/NYHAI and group CAG(+)/NYHAI which were 12.76±0.43 and 12.84±0.72 respectively (P＜0.01). In addition, there have no difference between the heart failure group CAG(-)/NYHA II-IV and CAG(+)/NYHA II-IV group (P=0.916), and no difference between groups without heart failure (P=0.985). For instant, RDW remains an independent factor that associated with chronic heart failure (regression coefficient=0.879, OR=2.408, P＜0.01) after adjustment of other predictor and prognostic factor of heart failure such as age, hemoglobin, left ventricular ejection fraction, left atrial diameter, albumin and urea.Conclusion:Red cell distribution width has no predictive ability of coronary heart disease, but the elevation of RDW was highly and independently associated with chronic heart failure. Thus, RDW can be clinically used as a parameter in risk stratification of patients with heart failure. On the other hand, further investigation of how and why this indicator relates to chronic heart failure and study of related mechanism will allow us to better understand the pathophysiology of chronic heart failureObjective:The occurrence and development of coronary heart disease are ultimately associated with the size and function of platelet. Our study aimed to determine the clinical value of platelet distribution width (or platelet size deviation width, PDW) as an indicator for prediction or risk stratification of coronary heart disease by retrospective analysis of particular population.Methods:Our retrospective study had included 173 cases which admitted to our cardiologic department started from November 2008 to December 2009, coronary angiography were performed in all cases and clinical atrial fibrillation, dilated cardiomyopathy, rheumatic heart disease or any other organic heart diseases were ruled out. The control group NCHD were the patients without coronary heart disease confirmed by coronary angiographic examination, group SCHD were patients with stable type coronary heart disease confirmed diagnosis by coronary angiography, repeated coronary angiography examination or post-CABG were excluded; study group 2 defined as group ACS were the patents who suffering acute coronary syndrome episode (both myocardial infarction and unstable angina) at admission and received coronary angiography and interventional treatment thereafter. We used one way ANOWA to test the different of PDW between the groups. Further analysis of variance (ANOVA), single factor analysis and multivariate linear regression analysis were use to understand their co-relationship and relationship with other blood parameters and biochemical parameters.Results:The mean of PDW of group SCHD and ACS were 13.83±2.63 and 13.84±2.13 respectively, there have no difference found between the groups as both of them were associated with coronary heart disease (P=1.000), but their PDW were significantly higher than group NCHD which PDW was 12.55±2.07 (P＜0.01). We also found that the mean platelet volume (MPV) and platelet large cell ratio (P-LCR) were associated with coronary heart disease, they are higher in group SCHD than group NCHD 11.11±1.20 vs 10.48±0.88 and 32.74±9.96 vs 28.39±7.66 (P＜0.01), and there had no statistic difference between group SCHD and group ACS (P＞0.05). In addition, after adjustment for coronary heart disease-related risk factors such as age and gender, PDW remained independently associated with coronary heart disease (OR=1.338 for group SCHD and OR=1.352 for group ACS, P＜0.01).Conclusion:Platelet distribution width, mean platelet volume and the platelet large cell ratio are the platelet volume indicator that can reflex the variability of circulation platelet, their raise was highly and positively associated with coronary heart disease. Therefore they may be the valuable independent indicators for risk stratification and prediction of coronary heart disease and can be useful in clinical practice. Further investigation of the mechanisms associated with coronary heart disease and large platelet will allow us to better understand the mechanisms, the development and the pathophysiology of coronary heart disease. Last but not least, to seek for the best strategy for coronary heart disease prevention and treatment.