Department of Cardiology, Gaziantep State Hospital, Gaziantep, Turkey.
Heart Lung. 2012 May;41(3):238-43. doi: 10.1016/j.hrtlng.2011.07.011. Epub 2011 Oct 11.
Chronic obstructive pulmonary disease (COPD) is a progressively debilitating disease limiting patients' survival. The prognosis of COPD worsens with the addition of right ventricular (RV) failure. Red cell distribution width (RDW) is a measure of variability in the size of circulating erythrocytes, and is a powerful predictor of outcomes in patients with both chronic and acute left heart failure. Here we attempted to test whether RDW could provide an early marker of RV failure in patients with COPD.
Thirty-nine consecutive patients with COPD were enrolled in the study. All patients had at least 10 years' history of COPD, and all were treated appropriately. Thirty-nine age-matched and sex-matched individuals were enrolled for comparison. Red cell distribution width was obtained in all patients before transthoracic echocardiography. Right ventricular parameters were evaluated, and RV failure was identified via lateral tricuspid annulus longitudinal motion and systolic-tissue Doppler velocity, using transthoracic echocardiography.
Patients with COPD had significantly higher RDW values compared with control subjects (patients with COPD, mean ± SD, 16.1 ± 2.5; range, 12.3 to 23.3; control subjects, mean ± SD, 13.6 ± 1.3; range, 11.7 to 18.3; P < .001). In multivariable logistic regression, the presence of high RDW was the only parameter independently predicting RV failure in patients with COPD (odds ratio, 2.098; P = .017). Levels of RDW, obtained before echocardiography, predicted the presence of RV failure with a sensitivity of 70% and specificity of 93.1%, with a cutoff value of >17.7.
Red cell distribution width may be used to identify COPD patients with RV failure.
慢性阻塞性肺疾病（COPD）是一种进行性致残疾病，限制了患者的生存。随着右心室（RV）衰竭的加入，COPD 的预后恶化。红细胞分布宽度（RDW）是循环红细胞大小变异性的度量，是慢性和急性左心衰竭患者预后的有力预测指标。在这里，我们试图测试 RDW 是否可以为 COPD 患者的 RV 衰竭提供早期标志物。
研究纳入了 39 例连续 COPD 患者。所有患者均有至少 10 年 COPD 病史，且均接受了适当的治疗。为了进行比较，还纳入了 39 名年龄和性别匹配的个体。所有患者均在经胸超声心动图检查前获得了 RDW 值。通过经胸超声心动图评估右心室参数，并通过外侧三尖瓣环纵向运动和收缩组织多普勒速度识别 RV 衰竭。
与对照组相比，COPD 患者的 RDW 值明显更高（COPD 患者，平均值±SD，16.1±2.5；范围，12.3 至 23.3；对照组，平均值±SD，13.6±1.3；范围，11.7 至 18.3；P<.001）。在多变量逻辑回归中，高 RDW 的存在是 COPD 患者 RV 衰竭的唯一独立预测参数（优势比，2.098；P=.017）。在超声心动图检查之前获得的 RDW 水平可以预测 RV 衰竭的存在，其敏感性为 70%，特异性为 93.1%，截断值为>17.7。
RDW 可用于识别有 RV 衰竭的 COPD 患者。
