High red cell distribution width at the time of ST segment elevation myocardial infarction is better at predicting
Jasmina Ćatić1, Ivana Jurin, Marko Lucijanić
1Department of Cardiology, Clinical Hospital "Dubrava", Zagreb Faculty of Medicine, "J.J. Strossmayer" University of Osijek, Osijek Department of Hematology, Clinical Hospital "Dubrava" Department of Cardiology, Clinical Hospital "Merkur" Department of Cardiac and Transplant Surgery, Clinical Hospital "Dubrava", Zagreb, Croatia.
Insights
Elevated red cell distribution width (RDW) is linked to heart dysfunction after myocardial infarction. Higher RDW levels predict both systolic and diastolic dysfunction, particularly diastolic issues, in STEMI patients.
Area of Science:
- Cardiology
- Hematology
- Diagnostic Imaging
Background:
- Red cell distribution width (RDW) is associated with cardiac dysfunction.
- ST-elevation myocardial infarction (STEMI) is a critical cardiac event.
- Understanding predictors of post-STEMI dysfunction is crucial for patient outcomes.
Purpose of the Study:
- To investigate clinical associations of RDW in STEMI patients.
- To evaluate RDW's predictive properties for systolic and diastolic dysfunction.
- To compare RDW's discriminatory power for systolic versus diastolic dysfunction.
Main Methods:
- Prospective analysis of 89 STEMI patients.
- RDW measurement at STEMI diagnosis.
- Transthoracic echocardiography for systolic/diastolic function assessment (days 5-7 post-STEMI).
Main Results:
- RDW was associated with older age, hypertension, hyperlipoproteinemia, non-smoking, higher thrombolysis in myocardial infarction score, and multivessel disease.
- Higher RDW correlated with parameters of systolic dysfunction (reduced ejection fraction) and diastolic dysfunction (abnormal E/A and E/E' ratios).
- RDW showed better discrimination for diastolic dysfunction, especially when combined E/A < 1 and E/E' > 10.
Conclusions:
- Elevated RDW is significantly associated with systolic and diastolic dysfunction in STEMI patients, independent of confounding factors.
- RDW serves as a valuable, accessible biomarker for assessing cardiac dysfunction post-STEMI.
- RDW appears more effective in identifying diastolic dysfunction than systolic dysfunction in this cohort.
Abstract:
Multiple studies have demonstrated the association of red cell distribution width (RDW) with the ultrasound parameters of both systolic and diastolic heart dysfunction. We aimed to further investigate the clinical associations of RDW in the setting of ST-elevation myocardial infarction (STEMI) and to comparatively evaluate its predictive properties regarding systolic and diastolic dysfunction.A total of 89 patients with STEMI were prospectively analyzed. RDW was obtained at the time of STEMI and compared to the parameters of systolic and diastolic dysfunction obtained by transthoracic heart ultrasound on the 5th through 7th day post-STEMI.The median RDW was 13.9%, and among other factors, RDW was significantly associated with older age (P < .001), arterial hypertension (P = .017), hyperlipoproteinemia 2, nonsmoking (P = .027), increased thrombolysis in myocardial infarction score (P = .004), and multivessel disease (P = .007). A higher RDW was observed in patients with parameters that indicated systolic and diastolic dysfunction (ejection fraction of the left ventricle < 50% [P = .009], early/late diastolic filling wave ratio [E/A] < 1 [P = .001], ratio of peak early transmitral velocity and early diastolic annular velocity [E/E'] >10 [P < .001], and combined E/A < 1 and E/E' > 10 [P < .001]). The best discriminatory properties were observed for combined E/A < 1 and E/E' > 10. RDW remained significantly associated with the aforementioned parameters in a series of multivariate regression models.Elevated RDW is significantly associated with the parameters of systolic and diastolic dysfunction even after adjusting for several confounding factors in the setting of STEMI and subsequent percutaneous coronary intervention. RDW seems to be better at discriminating patients with diastolic rather than systolic dysfunction.
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