Author + information
- Hakan Akıllı,
- Mehmet Kayrak,
- Alpay Aribas,
- Hajrudin Alibasic,
- Oguzhan Yildirim,
- Ahmet Lütfi Sertdemir and
- Kurtulus Ozdemir
Red cell distribution width (RDW), a measurement of the heterogeneity in the size of circulating erythrocytes, is a novel risk marker for adverse outcomes in cardiovascular diseases such as stable coronary artery disease (CAD), heart failure, and acute coronary syndromes. In addition, the relationship between the severity and complexity of CAD and RDW has been presented angiographically. its role in demonstrating the presence and extent of myocardial ischemia for CAD is not known.
The purpose of this study is to investigate the relationship between RDW and the presence and extent of myocardial ischemia as detected by Dobutamine stress echocardiography (DSE).
Nine hundred seventeen patients who requested DSE (with ejection fraction> 40%) were included in this prospective study. Before undergoing DSE, blood samples were taken for a complete blood analysis. According to DSE results, patients were divided into two groups: DSE negative and positive. According to number ischemic segment in DSE, patients were divided into three groups: No-ischemic segment, 1-3 ischemic segments and ≥4 ischemic segments. In addition, coronary angiography results of DSE positive groups were assessed in respect of RDW.
The demographic characteristics and laboratory findings of the patients are presented in table. The RDW of the DSE positive group (n=277, mean age 60.5± 9.6 years) was significantly higher than the RDW of the DSE negative group (n=640, mean age 58.9 ± 9.9 years) (13.5±1.5 vs 12.7±1.3 %, respectively, p<0.001). RDW was also significantly different between the three groups that were evaluated in terms of ischemia number detected by DSE. The RDW for those no-ischemia was 12.7±1.3, was 13.2±1.5 for those with 1-3 segment ischemia, and was 14.2±1.3 for those with ≥4 segment ischemia (p<0.001) (Figure 1). A receiver operating curve analysis for those with ischemia indicated a RDW > 13.5 %, a sensitivity cut of value of 57.0%, a specificity of 77.8%, a positive predictive value of 52.7 %, and a negative predictive value of 80.7 % (Figure 2). In our study, while a positive predictive value of DSE was 82.4 % for CAD diagnosis, the positive DSE diagnosis value increased to 94.2 % when an RDW value >13.5 (%) was added.
RDW is related to the presence and extent of myocardial ischemia as detected by DSE.A high RDW increases the diagnostic accuracy of DSE.
|Parameters||DSE negative (n=640)|
|DSE positive (n=277)|
|Female gender n (%)||330 (51.6)||107 (38.6)||<0.001|
|BMI (kg/m 2)||28.3±3.2||28.4±3.3||0.77|
|Hypertension n (%)||155 (24.2)||102 (36.8)||0.01|
|Diabetes mellitus n (%)||176 (27.5)||87 (31.4)||0.26|
|Smoking n (%)||158 (24.7)||78 (28.1)||0.19|
|Family history n (%)||98 (15.3)||52 (18.8)||0.61|
|Known CAD n (%)||148 (23.1)||115 (41.5)||<0.01|
|Ejection Fraction (%)||58.9±5.8||57.4±7.7||0.02|
|Creatinine Clirence (ml/min)||94.4±23.1||94.6±22.1||0.92|
|Tothal Colesterol (mg/dl)||196.9±39.7||185.7±41.2||<0.001|
|Triglyceride (mg/dl)||131 (97)||127 (96)||0.09|
DSE: Dobutamine stress echocardiography, IQR: Interquartile range, BMI: Body mass index, BP: Blood pressure, CAD: Coronary artery disease, PCI: Percutaneous coronary intervention, CABG: coronary artery bypass grafting, MI: Myocardial infarction, LDL-C: Low-density lipoprotein cholesterol, HDL-C: High-density lipoprotein cholesterol, WBC: White blood cell, RDW: Red blood cell distribution with