Association between red cell distribution width RDW and hs-CRP in patients with Cardiac Syndrome X

Yıl 2013, Cilt: 2 Sayı: 1, 17 - 22, 01.01.2013

Mehmet Fatih Karakaş Eyüp Büyükkaya Mustafa Kurt Şule Büyükkaya Esra Karakaş Adnan Burak Akçay Nihat Şen

Öz

OBJECTIVE: Cardiac Syndrome X CSX is defined as typical chest pain, objective signs of ischemia and normal coronary arteries. The association between CSX and inflammation is well known. Red cell distribution width RDW , an index of erythrocyte size, is recently found to be associated with inflammation. We investigated the association between RDW and high sensitive C reactive protein hs-CRP in patients with CSX.METHODS: Total 104 patients were included in the study. Those with evidence of ischemia total of 70 underwent coronary angiography. Patients with a normal coronary angiogram were grouped as the CSX group n=35 and those with significant coronary disease were grouped as the coronary artery disease CAD group n=35 . A total of 34 patients were taken as the control group. RDW and hs-CRP levels were measuredRESULTS: RDW was increased in the CSX group when compared to the Control group 13.9 ± 1.2 vs 12.9 ±0.7, p < 0.001 . However, there was no difference between the CSX and CAD groups 13.9 ± 1.2 vs. 14,1 ± 1,1, p: 0. 63 . Both groups had higher hs-CRP levels than the Control group. RDW is correlated with hs-CRP r=0.24, p: 0.014 .CONCLUSION: RDW, a novel inflammatory marker, is elevated in CSX and may be promising biomarker in reflecting the inflammatory status in CSX patients.

Anahtar Kelimeler

Cardiac syndrome X, RDW, hs-CRP, inflammation

Kardiyak Sendrom X'de Eritrosit dağılım genişliği RDW ile hs-CRP seviyelerinin incelenmesi

Öz

AMAÇ: Kardiyak Sendrom X KSX , angina pektoris ve objektif iskemi bulgularına rağmen normal koroner arterlerin saptandığı bir tablodur. KSX’ in patogenezinde inflamasyonun rol oynadığı bulunmuştur. Eritrosit dağılım genişliği RDW , dolaşımdaki eritrositlerin büyüklüğünü gösteren bir indeks olmasının yanında, son çalışmalarda inflamasyonu gösteren bir parametre olarak değerlendirilmeye başlanmıştır. Biz bu çalışmada KSX olan hastalarda inflamasyon ile RDW arasındaki ilişkiyi araştırdıkYÖNTEMLER: Bu çalışmaya iskemik bulguların saptandığı koroner anjiyografisi normal olan 35 KSX hastası KSX grubu , ciddi koroner arter hastalığı bulunan 35 hasta KAH grubu ve 34 kontrol hastası alındı. Her üç gruptan RDW ve hs-CRP çalışıldıBULGULAR: KSX grubunda RDW değerleri kontrol grubuna göre artmış bulundu 13.9 ± 1.2 vs 12.9 ±0.7, p < 0.001 . Ancak KSX grubu ile KAH grubu arasında fark bulunmadı 13.9 ± 1.2 vs. 14,1 ± 1,1, p: 0. 63 . Aynı şekilde KSX ile KAH grubu arasında hs-CRP değerleri arasında fark yoktu 1.03 ± 0.5 vs. 1.05 ± 0.5, p: 0.92 . Kontrol grubunda hs-CRP düzeyi KSX ve KAH grubuna göre anlamlı bir şekilde düşük bulundu. RDW ile hs-CRP arasında pozitif korelasyon olduğu bulundu r=0.24, p: 0.014 . SONUÇ: RDW, klinikte uzun süredir bilinen ancak inflamatuvar marker olarak yeni kullanılan bir parametre olup KSX olan hastalarda yükselmektedir.

Anahtar Kelimeler

Kardiyak sendrom X, RDW, hs-CRP, inflamasyon

Kaynakça

• Kemp HG, Jr.: Syndrome X revisited. J Am Coll Cardiol 1991; 17: 507-508.
• Kemp HG, Kronmal RA, Vlietstra RE, Frye RL: Seven year survival of patients with normal or near normal coronary arteriograms: a CASS registry study. J Am Coll Cardiol 1986; 7: 479-483.
• Egashira K, Inou T, Hirooka Y, Yamada A, Urabe Y, Takeshita A: Evidence of impaired endothelium- dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. N Engl J Med 1993; 328: 1659-1664.
• Quyyumi AA, Cannon RO, 3rd, Panza JA, Diodati JG, Epstein SE: Endothelial dysfunction in patients with chest pain and normal coronary arteries. Circulation 1992; 86: 1864-1871.
• Vane JR, Anggard EE, Botting RM: Regulatory func- tions of the vascular endothelium. N Engl J Med 1990; 323: 27-36.
• İpek G, Bilen E, Kurt M, Karakaş MF, Arslantaş U, Yüksel İÖ, Yaşar AS, Bilge M. Metabolic syndrome and Gender Difference: Tissue Doppler Study. Abant Medical Journal. 2012; 1(2): 39-44
• On YK, Park R, Hyon MS, Kim SK, Kwon YJ: Are low total serum antioxidant status and elevated levels of C-reactive protein and monocyte chemotactic pro- tein-1 associated with cardiac syndrome X? Circ J 2005; 69: 1212-1217.
• Li JJ, Zhu CG, Nan JL, Li J, Li ZC, Zeng HS, Gao Z, Qin XW, Zhang CY: Elevated circulating inflammatory markers in female patients with cardiac syndrome X. Cytokine 2007; 40: 172-176.
• Dominguez-Rodriguez A, Abreu-Gonzalez P, Avanzas P, Gomez MA, Kaski JC: Elevated circulating soluble form of CD40 ligand in patients with cardiac syn- drome X. Atherosclerosis 2010; 213: 637-641.
• Bessman JD, Gilmer PR, Jr., Gardner FH: Improved classification of anemias by MCV and RDW. Am J Clin Pathol 1983; 80: 322-326.
• Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR, Altay H, Cinar Z, Tandogan I, Yilmaz MB: Usefulness of admission red cell distribution width as a predictor of early mortality in patients with acute pulmonary embolism. Am J Cardiol 2012; 109: 128- 134.
• Oh HJ, Park JT, Kim JK, Yoo DE, Kim SJ, Han SH, Kang SW, Choi KH, Yoo TH: Red blood cell distribution width is an independent predictor of mortality in acute kidney injury patients treated with continuous renal replacement therapy. Nephrol Dial Transplant 2012; 27: 589-594.
• Rhodes CJ, Wharton J, Howard LS, Gibbs JS, Wilkins MR: Red cell distribution width outperforms other potential circulating biomarkers in predicting surviv- al in idiopathic pulmonary arterial hypertension. Heart 2011; 97: 1054-1060.
• Ye Z, Smith C, Kullo IJ: Usefulness of red cell distribu- tion width to predict mortality in patients with pe- ripheral artery disease. Am J Cardiol 2011; 107: 1241-1245.
• Ani C, Ovbiagele B: Relation of baseline presence and severity of renal disease to long-term mortality in persons with known stroke. J Neurol Sci 2010; 288: 123-128.
• Fukuta H, Ohte N, Mukai S, Saeki T, Asada K, Wakami K, Kimura G: Elevated plasma levels of B-type natriu- retic Peptide but not C-reactive protein are associat- ed with higher red cell distribution width in patients with coronary artery disease. Int Heart J 2009; 50: 301-312.
• Isik T, Uyarel H, Tanboga IH, Kurt M, Ekinci M, Kaya A, Ayhan E, Ergelen M, Bayram E, Gibson CM: Rela- tion of red cell distribution width with the presence, severity, and complexity of coronary artery disease. Coron Artery Dis 2012; 23: 51-56.
• Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, Swedberg K, Wang D, Yusuf S, Michel- son EL, Granger CB: Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol 2007; 50: 40-47.
• Uyarel H, Ergelen M, Cicek G, Kaya MG, Ayhan E, Turkkan C, Yildirim E, Kirbas V, Onturk ET, Erer HB, Yesilcimen K, Gibson CM: Red cell distribution width as a novel prognostic marker in patients undergoing primary angioplasty for acute myocardial infarction. Coron Artery Dis 2011; 22: 138-144.
• Dabbah S, Hammerman H, Markiewicz W, Aronson D: Relation between red cell distribution width and clinical outcomes after acute myocardial infarction. Am J Cardiol 2010; 105: 312-317.
• Öztürk S, Öztürk S. Approach of dyslipidemia; as a cardiovascular risk factor. Abant Med J. 2012; 1: 89- 93
• Li JJ: Inflammation in coronary artery diseases. Chin Med J (Engl) 2011; 124: 3568-3575.
• Eroglu S, Elif Sade L, Yildirir A, Demir O, Bozbas H, Muderrisoglu H: Serum levels of C-reactive protein and uric acid in patients with cardiac syndrome X. Acta Cardiol 2009; 64: 207-211.
• Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi GC: Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med 2009; 133: 628-632.
• Montagnana M, Cervellin G, Meschi T, Lippi G: The role of red blood cell distribution width in cardiovas- cular and thrombotic disorders. Clin Chem Lab Med 2012; 50: 635-641.
• Marinkovic D, Zhang X, Yalcin S, Luciano JP, Brugnara C, Huber T, Ghaffari S: Foxo3 is required for the regu- lation of oxidative stress in erythropoiesis. J Clin In- vest 2007; 117: 2133-2144..