Relation of Red Cell Distribution Widht with Ascending Aortic Diameter in Bicuspid Aortic Valve Patients

Abstract

Objective: Red cell distribution widht (RDW) and neutrophil to lymphocyte ratio (NLR) plays a significant role in assessing the severity and progression of some cardiac conditions. Bicuspid aortic valve (BAV)-associated aortopathy is common and its progression for individual patients is difficult to predict. In this study, we aimed to investigate the association between serum levels of RDW, NLR and ascending aortic diameter (AAd) in BAV patients. Methods: A total of 182 consecutive patients with a BAV were recruited into this study. Complete blood counts were analyzed for RDW level and NLR. Patients were divided into two groups based on their AAd and patients with AAd of 3.9 and above were included in group 1, while those below 3.9 in group 2. Results: NLR was significantly higher in group 1 patients than those in group 2. RDW levels were similar. In univariate correlation analysis, a positive correlation was found between AAd and RDW and NLR in group 1 patients. In multivariate logistic regression analysis, RDW (odds ratio (OR): 1.78, 95% confidence interval (CI): 1.36–2.44, P = 0.01) remained as independent correlates of AAd in the patient population. Receiver operating characteristic (ROC) curve analysis reveled that a RDW measurement >13.0% predicted ascending aort dilatation (AAD) with a sensitivity of 58% and a specificity of 79%. Conclusion: RDW and NLR are positively correlated with AAd in BAV patients with AAD. These markers may point out the role of inflammation both in the pathogenesis and progression of AAD in these patients.

Keywords

• Bicuspid aortic valve
• ascending aortic diameter
• red cell distribution widht

References

1. 7. Cem Ö, Yilmaz S, Korkmaz A, Fahrettin T, Sahin I, Demir V. Evaluation of the neutrophil-lymphocyte ratio in newly diagnosed nondiabetic hypertensive patients with ascending aortic dilatation. Blood Press Monit. 2016 Aug;21(4):238-43.
2. 8. Güngör B, Özcan KS, Özpamuk Karadeniz F, Uluganyan M, Ekmekçi A, Alper AT, et al. Red cell distribution widht is increased in patients with ascending aortic dilatation. Turk Kardiyol Dern Ars. 2014 Apr;42(3):227-35.
3. 9. Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J 2009;158:659-66.
4. 10. Roberts WC. The congenitally bicuspid aortic valve: a study of 85 autopsy studies.Am J Cardiol. 1970;26(1):72-83.
5. 11. Hiratzka LF, Bakris GL, Beckman JA, Bersin RM, Carr VF, Casey DE Jr, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with Thoracic Aortic Disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine. Circulation 2010;121:266-69.
6. 12. Fedak PW, Verma S, David TE, Leask RL, Weisel RD, Butany J. Clinical and pathophsiological implications of a bicuspid aortic valve.Circulation. 2002;106(8):900-04.
7. 13. Michelena HI, Desjardins VA, Avierinos JF, Russo A, Nkomo VT, Sundt TM, et al. Natural history of asymptomatic patients with normally functioning or minimally dysfunctional bicuspid aortic valve in the community. Circulation 2008;21:2776-84.
8. 14. Hiratzka LF, Creager MA, Isselbacher EM, Svensson LG, Nishimura RA, Bonow RO, et al. Surgery for Aortic Dilatation in Patients With Bicuspid Aortic Valves: a statement of clarification from the American College of Cardiology/American Hear Associatiın Task force on Clinical Practice Guidelines. J Am Coll Cardiol. 2016 Feb 16;67(6):724-31.

9. 15. K. Clarke, R. Sagunarthy, and S. Kansal. RDW as an additional marker in inflammatory bowel disease/undifferentiated colitis. Digestive Diseases and Sciences 2008;53:2521-23.
10. 16. Mawlana W, Donia A, Elamrousy D. Relation between red cell distribution width and left ventricular function in children with heart failure. ISRN Pediatrics 2014;2014:234835.
11. 17. Kojima T, Yasuhara J, Kumamoto T, Shimizu H, Yoshiba S, Kobayashi T, Sumitomo N. Usefulness of the red blood cell distribution width to predict heart failure in patients with a Fontan circulation. Am J Cardiol 2015;116:965–68.
12. 18. Polat V, Iscan S, Etli M, El Kılıc H, G€ ursu O, Eker E, Ozdemir F. Red cell distribution width as a prognostic indicator in pediatric heart disease and after surgery. Biomed Res Int 2014;2014:681679.
13. 19. Rodriguez-Carrio J, Alperi-Lopez M, Lopez P, Alonso-Castro S, Carro-Esteban SR, Ballina Garcia FJ, Suarez A. Red cell distribution width is associated with endothelial progenitor cell depletion and vascularrelated mediators in rheumatoid arthritis. Atherosclerosis 2015;240:131–36.
14. References1. Roberts WC. The congenitally bicuspid aortic valve. A study of 85 autopsy cases. Am J Cardiol 1970;26:72–83.
15. 2. Sabet HY, Edwards WD, Tazelaar HD, Daly RC. Congenitally bicuspid aortic valves: a surgical pathology study of 542 cases (1991 through 1996) and a literature review of 2,715 additional cases. Mayo Clin Proc 1999;74:14–26.
16. 3. Nistri S, Sorbo MD, Marin M, Palisi M, Scognamiglio R, Thiene G. Aortic root dilatation in young men with normally functioning bicuspid aortic valves. Heart 1999;82:19–22.
17. 4. Beroukhim RS, Kruzick TL, Taylor AL, Gao D, Yetman AT. Progression of aortic dilation in children with a functionally normal bicuspid aortic valve. Am J Cardiol 2006;98:828–30.
18. 5. Kang JW, Song HG, Yang DH, Baek S, Kim DH, Song JM et al. Association between bicuspid aortic valve phenotype and patterns of valvular dysfunction and bicuspid aortopathy: comprehensive evaluation using MDCT and echocardiography. JACC Cardiovasc Imaging 2013;6:150–61.
19. 6. Della Corte A, Bancone C, Buonocore M, Dialetto G, Covino FE, Manduca Set al. Pattern of ascending aortic dimensions predicts the growth rate of the aorta in patients with bicuspid aortic valve. JACC Cardiovasc Imaging 2013;6:1301–10.