Lazzeroni Davide, Moderato Luca, Marazzi P L, Pellegrino Carmen, Musiari Elisa, Castiglioni Paolo, Camaiora Umberto, Bini Matteo, Geroldi Simone, Brambilla Lorenzo, Brambilla Valerio, Coruzzi Paolo
IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
, Piazzale dei Servi, n°3, 43121, Parma, Italy.
Sci Rep. 2021 Apr 12;11(1):7889. doi: 10.1038/s41598-021-87075-4.
The red blood cell distribution width (RDW) measures the variability in the size of circulating erythrocytes. Previous studies suggested a powerful correlation between RDW obtained from a standard complete blood count and cardiovascular diseases in both primary and secondary cardiovascular prevention. The current study aimed to evaluate the prognostic role of RDW in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. The study included 1.031 patients with available RDW levels, prospectively followed for a mean of 4.5 ± 3.5 years. The mean age was 68 ± 12 years, the mean RDW was 14.7 ± 1.8%; 492 patients (48%) underwent cardiac rehabilitation after myocardial revascularization, 371 (36%) after cardiac valve surgery, 102 (10%) after valve-plus-coronary artery by-pass graft surgery, 66 (6%) for other indications. Kaplan-Meier analysis and Cox hazard analysis were used to associate RDW with mortality. Kaplan-Meier analysis demonstrated worse survival curves free from overall (log-rank p < 0.0001) and cardiovascular (log-rank p < 0.0001) mortality in the highest RDW tertile. Cox analysis showed RDW levels correlated significantly with the probability of overall (HR 1.26; 95% CI 1.19-1.32; p < 0.001) and cardiovascular (HR 1.31; 95% CI 1.23-1.40; p < 0.001) mortality. After multiple adjustments for cardiovascular risk factors, hemoglobin, hematocrit, C-reactive protein, microalbuminuria, atrial fibrillation, glomerular filtration rate,left ventricular ejection fraction and number of exercise training sessions attended, the increased risk of overall (HR 1.10; 95% CI 1.01-1.27; p = 0.039) and cardiovascular (HR 1.13; 95% CI 1.01-1.34; p = 0.036)mortality with increasing RDW values remained significant. The RDW represents an independent predictor of overall and cardiovascular mortality in secondary cardiovascular prevention patients undergoing cardiac rehabilitation.
红细胞分布宽度（RDW）用于测量循环红细胞大小的变异性。既往研究表明，在原发性和继发性心血管疾病预防中，标准全血细胞计数得出的RDW与心血管疾病之间存在密切关联。本研究旨在评估RDW在心肌血运重建和/或心脏瓣膜手术后接受心脏康复治疗的患者中的预后作用。该研究纳入了1031例有可用RDW水平的患者，前瞻性随访平均4.5±3.5年。平均年龄为68±12岁，平均RDW为14.7±1.8%；492例（48%）患者在心肌血运重建后接受心脏康复治疗，371例（36%）在心脏瓣膜手术后接受治疗，102例（10%）在瓣膜加冠状动脉搭桥手术后接受治疗，66例（6%）因其他适应证接受治疗。采用Kaplan-Meier分析和Cox风险分析将RDW与死亡率相关联。Kaplan-Meier分析显示，在RDW最高三分位数组中，总体生存曲线（对数秩检验p<0.0001）和心血管疾病生存曲线（对数秩检验p<0.0001）较差。Cox分析显示，RDW水平与总体死亡概率（HR 1.26；95%CI 1.19-1.32；p<0.001）和心血管疾病死亡概率（HR 1.31；95%CI 1.23-1.40；p<0.001）显著相关。在对心血管危险因素、血红蛋白、血细胞比容、C反应蛋白、微量白蛋白尿、心房颤动、肾小球滤过率、左心室射血分数和参加运动训练课程次数进行多次调整后，随着RDW值升高，总体死亡风险（HR 1.10；95%CI 1.01-1.27；p=0.039）和心血管疾病死亡风险（HR 1.13；95%CI 1.01-1.34；p=0.036）增加的情况仍然显著。RDW是接受心脏康复治疗的继发性心血管疾病预防患者总体和心血管疾病死亡的独立预测因素。
