Yaegashi Daiki, Oikawa Masayoshi, Yokokawa Tetsuro, Misaka Tomofumi, Kobayashi Atsushi, Kaneshiro Takashi, Yoshihisa Akiomi, Nakazato Kazuhiko, Ishida Takafumi, Takeishi Yasuchika
Department of Cardiovascular Medicine, Fukushima Medical University, Fukushima, Japan.
Front Cardiovasc Med. 2020 Oct 30;7:594685. doi: 10.3389/fcvm.2020.594685. eCollection 2020.
Red blood cell distribution width (RDW) is associated with prognosis in widespread cardiovascular fields, but little is known about relationship with the onset of cancer therapeutics-related cardiac dysfunction (CTRCD). The purpose of this study was to assess whether RDW could predict the onset of CTRCD by anthracycline. Consequential 202 cancer patients planed for anthracycline treatment were enrolled and followed up for 12 months. The patients were divided into 2 groups based on the median value of baseline RDW before chemotherapy [low RDW group, = 98, 13.0 [12.6-13.2]; high RDW group, = 104, 14.9 [13.9-17.0]]. Cardiac function was assessed serially by echocardiography at baseline (before chemotherapy), as well as at 3, 6, and 12 months after chemotherapy with anthracycline. Baseline left ventricular end systolic volume index and ejection fraction (EF) were similar between two groups. After chemotherapy, EF decreased at 3- and 6-month in the high RDW group [baseline, 64.5% [61.9-68.9%]; 3-month, 62.6% [60.4-66.9%]; 6-month, 63.9% [60.0-67.9%]; 12-month, 64.7% [60.8-67.0%], = 0.04], but no change was observed in low RDW group. The occurrence of CTRCD was higher in high RDW group than in low RDW group (11.5 vs. 2.0%, = 0.008). When we set the cut-off value of RDW at 13.8, sensitivity and specificity to predict CTRCD were 84.6 and 62.0%, respectively. Multivariable logistic regression analysis revealed that baseline RDW value was an independent predictor of the development of CTRCD [odds ratio 1.390, 95% CI [1.09-1.78], = 0.008]. The value of net reclassification index (NRI) and integrated discrimination improvement (IDI) for detecting CTRCD reached statistical significance when baseline RDW value was added to the regression model including known risk factors such as cumulative anthracycline dose, EF, albumin, and the presence of hypertension; 0.9252 (95%CI 0.4103-1.4402, < 0.001) for NRI and 0.1125 (95%CI 0.0078-0.2171, = 0.035) for IDI. Baseline RDW is a novel parameter to predict anthracycline-induced CTRCD.
红细胞分布宽度（RDW）与广泛的心血管领域的预后相关，但关于其与癌症治疗相关心脏功能障碍（CTRCD）发病的关系知之甚少。本研究的目的是评估RDW是否可以预测蒽环类药物引起的CTRCD的发病。因此，纳入了202例计划接受蒽环类药物治疗的癌症患者，并随访12个月。根据化疗前基线RDW的中位数将患者分为两组[低RDW组，n = 98，13.0[12.6 - 13.2]；高RDW组，n = 104，14.9[13.9 - 17.0]]。在基线（化疗前）以及蒽环类药物化疗后3、6和12个月通过超声心动图连续评估心脏功能。两组之间的基线左心室收缩末期容积指数和射血分数（EF）相似。化疗后，高RDW组在3个月和6个月时EF下降[基线，64.5%[61.9 - 68.9%]；3个月，62.6%[60.4 - 66.9%]；6个月，63.9%[60.0 - 67.9%]；12个月，64.7%[60.8 - 67.0%]，P = 0.04]，但低RDW组未观察到变化。高RDW组CTRCD的发生率高于低RDW组（11.5%对2.0%，P = 0.008）。当我们将RDW的临界值设定为13.8时，预测CTRCD的敏感性和特异性分别为84.6%和62.0%。多变量逻辑回归分析显示，基线RDW值是CTRCD发生的独立预测因子[比值比1.390，95%可信区间[1.09 - 1.78]，P = 0.008]。当将基线RDW值添加到包括累积蒽环类药物剂量、EF、白蛋白和高血压存在等已知危险因素的回归模型中时，检测CTRCD的净重新分类指数（NRI）和综合判别改善（IDI）值达到统计学意义；NRI为0.9252（95%可信区间0.4103 - 1.4402，P < 0.001），IDI为0.1125（95%可信区间0.0078 - 0.2171，P = 0.035）。基线RDW是预测蒽环类药物引起的CTRCD的一个新参数。
