Kowara Michał, Grodecki Kajetan, Huczek Zenon, Puchta Dominika, Paczwa Katarzyna, Rymuza Bartosz, Zbroński Karol, Filipiak Krzysztof J, Opolski Grzegorz
1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Kardiol Pol. 2017;75(1):42-47. doi: 10.5603/KP.a2016.0137. Epub 2016 Oct 7.
The role of platelets in the pathophysiology of acute coronary syndromes (ACS) is undeniable, but precise relationships between platelet activity and treatment outcomes are a matter of continuant investigation. Among platelet indices, mean platelet volume (MPV) has proven to be a valuable predicting factor in cardiac patients. However, platelet distribution width (PDW) is reported to be a more specific marker of platelet reactivity. Thus, application of PDW in risk stratification of ACS treatment is an up-to-date subject of research. PDW values in the assessment of left ventricular (LV) function have not been previously studied.
The aim of the study was to evaluate whether admission PDW can predict LV systolic function in patients with ACS treated with stent implantation.
On-admission PDW was measured in 278 consecutive patients with diagnosis of ACS, who underwent stent(s) implantation. Echocardiogram with LV ejection fraction (LVEF) estimation was performed within 24 h of percutaneous coronary intervention. Additionally, patients were under one-year follow-up, and one-year all-cause mortality was assessed.
According to receiver-operating characteristics (ROC) analysis, a PDW value greater than 12.8 fL could predict LVEF ≤ 35% with sensitivity of 81% and specificity of 39% (AUC 0.614; p = 0.0177). Only a trend was noted in ROC for PDW and one-year mortality (AUC 0.608; p = 0.0815). Multivariate logistic regression analysis has shown that the PDW parameter correlates independently with both systolic heart failure with LVEF ≤ 35% (PDW cut-off: 12.8 fL, OR 2.8107, CI 1.1401-6.9293, p = 0.0248) and one-year mortality (PDW cut-off: 16 fL, OR 2.6750, CI 1.0190-7.0225, p = 0.0457).
Admission PDW may serve as a simple and widely available predictor of impaired LV function in patients with ACS. Association between PDW and mortality needs to be confirmed in larger studies.
血小板在急性冠脉综合征（ACS）病理生理学中的作用不可否认，但血小板活性与治疗结果之间的确切关系仍在持续研究中。在血小板指标中，平均血小板体积（MPV）已被证明是心脏病患者的一个有价值的预测因素。然而，据报道血小板分布宽度（PDW）是血小板反应性更特异的标志物。因此，将PDW应用于ACS治疗的风险分层是一个最新的研究课题。此前尚未研究过PDW值在评估左心室（LV）功能方面的情况。
本研究的目的是评估入院时的PDW是否能够预测接受支架植入治疗的ACS患者的左心室收缩功能。
对278例连续诊断为ACS并接受支架植入的患者测量入院时的PDW。在经皮冠状动脉介入治疗后24小时内进行评估左心室射血分数（LVEF）的超声心动图检查。此外，对患者进行为期一年的随访，并评估一年全因死亡率。
根据受试者工作特征（ROC）分析，PDW值大于12.8 fL可预测LVEF≤35%，敏感性为81%，特异性为39%（AUC 0.614；p = 0.0177）。在ROC曲线中，PDW与一年死亡率之间仅观察到一种趋势（AUC 0.608；p = 0.0815）。多因素逻辑回归分析表明，PDW参数与LVEF≤35%的收缩性心力衰竭（PDW临界值：12.8 fL，OR 2.8107，CI 1.1401 - 6.9293，p = 0.0248）和一年死亡率（PDW临界值：16 fL，OR 2.6750，CI 1.0190 - 7.0225，p = 0.0457）均独立相关。
入院时的PDW可作为ACS患者左心室功能受损的一种简单且广泛可用的预测指标。PDW与死亡率之间的关联需要在更大规模的研究中得到证实。
