Red Blood Cell Distribution Width In Patients With Previous Myocardial Infarction Heart Failure

Objective: With the continuous improvement of people's living standard,coronary heart disease, hypertension and other cardiovascular diseaseincidence rises gradually, the prevalence of heart failure, readmission rates,and mortality rate also increased year by year,5years mortality rate is about50%, similar to malignant tumor. And with the medical technology to improve,acute myocardial infarction mortality rate decreased gradually, old myocardialinfarction (OMI) patients are increasing, now it has become one of thecommon causes of heart failure. Red blood cell distribution width (RDW), is aroutine blood test in a common index, can reflect the discrete degree ofperipheral blood red cell volume distribution, always as one of the indicatorsanemia classification, and in recent years the research[1,2]shows that: RDW incardiovascular disease, especially in disease severity and prognosis of patientswith heart failure and coronary heart disease, have important value. Therefore,in the patients with OMI in early diagnosis of heart failure, and accuratelyunderstand the prognosis of heart failure, to guide the clinical treatment, so asto improve the survival rate of patients, improve the quality of life of patientshas important significance, This study aimed to analyze the RDW changes inOMI patients with heart failure, to explore the RDW's prognosis function inOMI patients with heart failure, as well as the RDW in OMI patients withheart failure as a new diagnostic laboratory indicators of possibility, andanalysis of the relationship of RDW and brain natriuretic peptide (BNP), NewYork Heart Association (NYHA) classification of cardiac function and leftventricular ejection fraction (LVEF) relationship.Method: Continuously observation of183patients with OMI, accordingto NYHA classification of cardiac function of patients, divided into Ⅰ, Ⅱ, Ⅲand Ⅳ, NYHA cardiac funtion grade Ⅰ of the patients scheduled for non heart failure group (111cases), NYHA cardiac funtion grade Ⅱ, Ⅲ and Ⅳpatients as heart failure group (72cases). Analysis of patients admitted tohospital after the general clinical data, including sex, age, body mass index,blood pressure, herat rate, whether or not combined with hypertension,diabetes, atrial fibrillation, percutaneous coronary interventional therapy (PCI),coronary artery bypass grafting (CABG), and left atrial diameter (LA), leftventricular end-diastolic diameter (LVEDD), LVEF, creatinine (Cr), RDW andBNP. The first of the above information in the various risk factors respectively,were analyzed by t test and χ2test,and then to have statistically significantrisk factors for Logistics regression analysis, to discuss the prognostic rickfactors of OMI heart failure, and using Spearman or Pearson analysis todiscuss the correlation between RDW and BNP, NYHA cardiac functionclassification, LVEF.Result: In183cases of OMI patients with heart failure, men accountedfor72.13%,37~86years old, average (68±12) years old, body mass index,systolic blood pressure, diastolic blood pressure and heart rate were fluctuatedin the19.84~32.65kg/m2,102~189mmHg,54~104mmHg,44~109times/min;hypertension, diabetes, atrial fibrillation, PCI, CABG respectively is72.68%,46.45%,15.30%,26.23%,3.28%; LA, LVEDD, LVEF, Cr, RDW and BNP'srange respectively is29~50mm,44~80mm,21~70%,47.4~141.9umol/L,10.2~17.5%,362~3679pg/ml. Compared with the non heart failure group, theheart failure group's male ratio is lower, but it was not statistically significant(P>0.05); the heart failure group has older age (P<0.01), rapidder heart rate(P<0.01); the heart failure group's body mass index, systolic and diastolicblood pressure were lower (all P<0.05); the patients with hypertension ratio ishigher (P<0.01), with diabetes, atrial fibrillation ratio is higher (both P<0.05),with PCI, CABG ratio is lower (both P<0.05); the heart failure group's LAand LVEDD significantly expanded (both P<0.01), but LVEF were lower(P<0.01), Cr, RDW and BNP were increased significantly (all P<0.01).NYHA cardiac function grade Ⅰ is111cases,40cases in grade Ⅱ,16casesin grade Ⅲ,16cases in grade Ⅳ, its RDW (mean±SD) respectively were (13.22±1.09),(14.15±0.58),(14.40±0.44),(14.58±0.68), BNP(mean±SD)respectively were (483.08±90.55),(1079.90±367.11),(2091.25±191.82),(3210.00±383.24), LVEF(mean±SD) respectively were (58.78±5.87),(51.20±9.24),(46.25±4.41),(32.00±7.83). The RDW level in heart failuregroup (14.30±0.60) is higher than that in non heart failure group(13.22±1.09)(P<0.01), the BNP level in heart failure group (1776.00±930.50)is higher than that in non heart failure group (483.08±90.55)(P<0.01), but theLVEF level in heart failure group (45.83±11.10) is lower than that in non heartfailure group (58.78±5.87)(P<0.01). The results of the statistically significantrisk factors (such as age, body mass index, blood pressure, heart rate, whetheror not combined with hypertension, diabetes, atrial fibrillation, PCI, CABG,LA, LVEDD, LVEF, Cr, BUN, RDW and BNP) of Logistics regressionanalysis showed: in the72cases of heart failure patients, using Logisticsregression equation predicted56cases, the correct rate is77.8%(56/72); inthe111cases of non heart failure group, using Logistics regression equationpredicted105cases, the correct rate is94.6%(105/111). The independentvariables entered into the regression equation were hypertension, LA, LVEF,RDW and BNP, chi-square test: χ2=36.420, P=0.000, this Logisticsregression equation has statistical significance. Logistics regression equation:LogitP=0.032+3.866hypertension+0.211LA-0.230LVEF+2.187RDW+0.034BNP. This study used5rick factors (hypertension, LA, LVEF, RDW and BNP)Logistics regression coefficient to reflect these5rick factors's role on p/(1-p)(the ratio of the incidence probability of heart failure in OMI patients to theoccurrence probability of that). The ratio of the onset of heart failure in OMIpatients with hypertension to the patients without hypertension is47.739, theratio of the onset of heart failure in OMI patients about the LA value is1.235,the ratio of the onset of heart failure in OMI patients about the LVEF value is0.794, the ratio of the onset of heart failure in OMI patients about the RDWnumerical size is0.112, the ratio of the onset of heart failure in OMI patientsabout the BNP numerical size is1.034. Prove that RDW is associated with thepoor prognosis of OMI heart failure patients. Spearman linear correlation analysis revealed, heart failure group's RDW level and heart functionclassification correlation (r=0.622, P<0.01); Pearson linear correlation analysisrevealed that, heart failure group's RDW level was positively related to BNP(r=0.563, P<0.01), and negative correlated to LVEF (r=-0.383, P<0.01).Conclusion: In a lot of risk factors, the RDW and BNP level of the heartfailure group in the OMI patients is significantly increased than than of nonheart failure group, but the LVEF level is lower. And the RDW level of OMIpatients with heart failure has prognosis prediction value. The RDW of OMIheart failure patients is positively correlated with BNP and NYHAclassification of cardiac function, negatively correlated with LVEF.