The Correlation Study Of Red Blood Cell Volume Distribution Width, Glomerular Filtration Rate And Chronic Heart Failure

Objective: In this study, taking New York Heart Association（NYHA）heart function classification, brain natriuretic peptide （BNP）, echocardiographyparameters, left ventricular mass （LVM） and left ventricular mass index （LVMI）as evaluation indexes of the level of heart function and degree of left ventricularremodeling in patients with chronic heart failure（CHF）. Analyzed thecorrelation of red blood cell volume distribution width（RDW）, glomerularfiltration rate（GFR） and the severity of CHF through the retrospective study,and discussed the possible mechanism and significance.Methods：Totally160inpatients with CHF were selected from theDepartment of Cardiology, the Second Hospital of Hebei Medical Universitybetween May2010and February2012. CHF was diagnosed with diseasehistory, clinical manifestation, physical examination and echocardiographyexamination, etc. Among160cases, there were76males and84females, theage ranged from43to88years old, the average age was64.01±10.56yearsold. According to the basic heart disease: there were60cases with ischemiccardiomyopathy,42cases with dilated cardiomyopathy,38cases withrheumatic heart disease,20cases with hypertensive heart disease. Accordingto NYHA heart function classification: there were52cases with heart functionclassⅡ,58cases with heart function class Ⅲ,50cases with heart functionclassⅣ.40inpatients without CHF were selected from the Department ofCardiology during the same period as control group. Among40cases, therewere20males and20females, the age ranged from51to70years old, theaverage age was62.50±5.72years old.Exclusion criteria:1)gastrointestinal hemorrhage;2)malignant tumors,radiotherapy, chemotherapy and organ transplantation;3)autoimmune disease;4)congenital heart disease;5)chronic obstructive pulmonary disease;6) hyperthyroidism;7)acute myocardial infarction within six months, PCI orother surgeries within three months;8)a serious infection within a month;9)primary liver and kidney disease, secondary liver and kidney disease causedby the other clear diseases;10)serious liver and kidney dysfunction,hemodialysis.Registered sex, age, height, weight and NYHA heart functionclassification of these inpatients. Collected the patients’ blood in fastingcondition to get the determination of RDW, HGB, Scr and BNP on the earlymorning of the next day. And took echocardiography examination todetermine LVEDd, IVSd, LVPWd and LVEF within three days.Calculated left ventricular mass （LVM） and left ventricular mass index（LVMI） by Devereux formula: LVM=0.8×1.04×[（LVEDd+IVSd+LVPWd）³-LVEDd³]+0.6. LVMI=LVM/BSA, BSA=0.0061×height+0.0128×weight-0.1529. Calculated glomerular filtration rate（GFR） by improved MDRDformula: GFR=175×（Scr）^-1.234×（age）^-0.179×（0.79female）.The units in the above formula: LVM（g）, LVEDd（cm）, IVSd（cm）,LVPWd（cm）, LVMI（g/m²）, BSA（m²）, weight （kg）, height （cm）, age（year）,Scr（mg/d1）, GFR(ml·min^-1·1.73m^-2).The diagnosis standard of anemia: in the sea level regions of China, adultmale HGB<120g/L, adult female （non-pregnancy） HGB<110g/L, pregnantwomen HGB<100g/L; RDW>15.5%was defined as RDW increased; Scr>133μmol/L was defined as Scr increased; Staging of renal function in NKF-K/DOQI: normal renal function GFR≥90ml/min, mild decline of renalfunction GFR60⁸9ml/min, moderate decline of renal function GFR30⁵9ml/min, serious decline of renal function GFR15²9ml/min, renalfailure GFR<15ml/min.CHF patients were grouped by NYHA heart function classification, theabove indexes were compared among groups, and analyzed the correlation ofRDW, GFR and the severity of CHF.The data were statistically treated by SPSS18.0. Measurement data（obeyed normal distribution） were expressed as mean±standard deviation （x±s）, count data were expressed as frequency and percentage. Means amonggroups were compared by one-way ANOVA. After the Levene test ofhomogeneity of variance, if the variance was homogeneous, LSD test wasused for comparison among groups, if the variance was irregular, Dunnett’s T3test was used for comparison among groups. Pearson correlation analysis wasused for the correlation analysis between two variables. The difference had astatistical significance when P<0.05.Results: Among160cases of CHF group, there were32（20%） CHF patientswith anemia,62（38.8%） CHF patients with RDW increased（RDW>15.5%）,30（18.8%） CHF patients with RDW increased and anemia,32（20%） CHFpatients with RDW increased but without anemia.Among160cases, there were4（2.5%） CHF patients with Scr increased（Scr>133μmol/L）,136（85%） CHF patients with mild to moderate decline ofrenal function,86（53.7%） CHF patients with mild decline of renal function（GFR60⁸9ml/min）,50（31.3%） CHF patients with moderate decline of renalfunction （GFR30⁵9ml/min）,4（2.5%） CHF patients with moderate decline ofrenal function and Scr increased, and132（82.5%） CHF patients with mild tomoderate decline of renal function but without Scr increased.With the gradual increase of NYHA heart function classification, thelevels of RDW, Scr, BNP, LVEDd, IVSd, LVPWd, LVM and LVMI showedthe gradually increased tendency, and the levels of GFR、LVEF、HGBshowed the gradually decreased tendency.The differences of the levels of RDW, HGB, Scr, GFR, BNP, LVEF,LVEDd, LVM and LVMI among groups all had statistical significances.（P<0.05）The differences of the levels of IVSd and LVPWd between control groupand NYHA class Ⅳ group had statistical significances.（P<0.05） And thedifferences among the other groups had no statistical significance.（P>0.05）Pearson correlation analysis of the indexes in CHF group: RDW had apositive correlation with BNP, LVEDd, LVM and LVMI, r:0.652,0.639,0.420,0.432, P<0.01; RDW had a negative correlation with GFR, HGB and LVEF, r:-0.532,-0.815,-0.733, P<0.01; RDW had no obvious correlationwith IVSd and LVPWd, r:0.129,0.132, P>0.05.GFR had a negative correlation with BNP, LVEDd, LVM, and LVMI, r:-0.481,-0.377,-0.199,-0.333, P:<0.01,<0.01,<0.05,<0.01; GFR had apositive correlation with HGB and LVEF, r:0.659,0.456, P<0.01; GFR hadno obvious correlation with IVSd and LVPWd, r:-0.037,0.003, P>0.05.HGB had a negative correlation with BNP, LVEDd, LVM and LVMI, r:-0.479,-0.418,-0.249,-0.284, P<0.01; HGB had a positive correlation withLVEF, r:0.531, P<0.01; HGB had no obvious correlation with IVSd andLVPWd, r:-0.046,-0.035, P>0.05.Conclusion: The levels of RDW and GFR had a remarkable correlationwith the severity of CHF: In patients with CHF, the worse the heart functionwas, the more severe the left ventricular remodeling was, the patients wouldhave higher level of RDW and lower level of GFR. RDW and GFR could beused as two powerful indexes to evaluate the severity of CHF.