Red blood cell distribution width as a novel prognostic marker after myocardial revascularization or cardiac valve surgery

AbstractThe 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.

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4951Long-term prognostic value of adherence to leisure time physical activity prescription in patients undergoing exercise-based cardiac rehabilitation: an inverse dose-response relationship

European Heart Journal ◽

10.1093/eurheartj/ehz746.0021 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

D Lazzeroni ◽

M Bini ◽

C Mari ◽

U Camaiora ◽

E Battistini ◽

...

Keyword(s):

Physical Activity ◽

Prognostic Value ◽

Leisure Time ◽

Leisure Time Physical Activity ◽

Myocardial Revascularization ◽

Cardiovascular Prevention ◽

Valve Surgery ◽

Cardiac Valve ◽

Cardiac Valve Surgery

Abstract Background The benefits associated with leisure time physical activity (LTPA) in primary and secondary cardiovascular prevention has been known for decades. Although several studies demonstrated that exercise-based cardiac rehabilitation (CR) programs reduce mortality, the long-term prognostic value of adherence to LTPA presciption after exercise-based CR has not been well estrablished. Purpose Evaluate the long-term prognostic value of adherence to LTPA presciption after exercise-based CR in patients undergoing myocardial revascularization and/or cardiac valve surgery. Methods A prospective registry of 2.340 consecutive patients, admitted to the Cardiovascular Prevention and Rehabilitation Unit was created. All patients completed a standard in-hospital CR program. Data regarding LTPA and outcomes were collected. End points were: overall and cardiovascular (CV) mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). The population has been classified into: 1) Physical inactivity: almost completely sedentary or occasional physical activity; 2) Physical activity: regular aerobic LTPA. The amount of LTPA was further collected according to minutes per week. Results A total of 1.892 patients with available data on LTPA and outcomes were included in the study; mean follow-up was 50±23 months. One-thousand and twenty-two (54%) patients underwent myocardial revascularization (CABG), 662 (35%) cardiac valve surgery, 208 (11%) combined valve and CABG surgery. Adherence to a regular LTPA was found in the 42% (792 participants) of the population, while 58% (1.100 patients) reported occasional LTPA or a complete physical inactivity. Kaplan-Meier survival curve showed a lower overall mortality (p<0.0001), CV mortality (p<0.0001), and MACCEs (p<0.0001) in LTPA group (figure). After adjustment for age, gender, arterial hypertension, diabetes, type of intervention, glomerular filtration rate and left ventricular ejection fraction, both overall and CV mortality were significantly lower in the LTPA groups (OR=0.24; p<0.0001 and OR=0.35; p<0.046, respectively), as well as combined MACCEs (OR=0.36; p<0.0001). Moreover, an inverse relationship between the increase of minutes per week of LTPA and the decrease of overall (HR 0.990; p<0.0001), CV mortality (HR 0.991; p<0.0001) and MACCEs (HR 0.996; p<0.0001) was found, with 1% reduction of relative risk of events for each minute per week increase of physical activity. Finally, comparing LTPA to standard medical therapy in our population, LTPA showed the lowest number needed to treat (NNT) to save a life (NTT=12). Central figure Conclusion Adherence to leisure time physical activity prescription is independently associated with significant reduction of overall mortality, CV mortality and MACCEs on top of exercise-based CR program after myocardial revascularization and/or cardiac valve surgery. Acknowledgement/Funding None

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Red cell distribution width is a prognostic marker of perioperative stroke in patients undergoing cardiac valve surgery

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivx216 ◽

2017 ◽

Vol 25 (6) ◽

pp. 925-929 ◽

Cited By ~ 14

Author(s):

Piotr Duchnowski ◽

Tomasz Hryniewiecki ◽

Mariusz Kuśmierczyk ◽

Piotr Szymański

Keyword(s):

Prognostic Marker ◽

Valve Surgery ◽

Cardiac Valve ◽

Red Cell Distribution Width ◽

Red Cell ◽

Cell Distribution ◽

Distribution Width ◽

Perioperative Stroke ◽

Cardiac Valve Surgery

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Cardiac rehabilitation in cardiac valve surgery patients: Beyond cost-effectiveness

European Journal of Preventive Cardiology ◽

10.1177/2047487317706180 ◽

2017 ◽

Vol 24 (11) ◽

pp. 1145-1147 ◽

Cited By ~ 1

Author(s):

Ana Abreu

Keyword(s):

Cost Effectiveness ◽

Cardiac Rehabilitation ◽

Valve Surgery ◽

Cardiac Valve ◽

Cardiac Valve Surgery

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Prognostic value of frontal QRS-T angle in patients undergoing myocardial revascularization or cardiac valve surgery

Journal of Electrocardiology ◽

10.1016/j.jelectrocard.2018.08.028 ◽

2018 ◽

Vol 51 (6) ◽

pp. 967-972 ◽

Cited By ~ 5

Author(s):

Davide Lazzeroni ◽

Matteo Bini ◽

Umberto Camaiora ◽

Paolo Castiglioni ◽

Luca Moderato ◽

...

Keyword(s):

Prognostic Value ◽

Myocardial Revascularization ◽

Valve Surgery ◽

Cardiac Valve ◽

Cardiac Valve Surgery

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Serum uric acid level predicts adverse outcomes after myocardial revascularization or cardiac valve surgery

European Journal of Preventive Cardiology ◽

10.1177/2047487317744045 ◽

2017 ◽

Vol 25 (2) ◽

pp. 119-126 ◽

Cited By ~ 10

Author(s):

Davide Lazzeroni ◽

Matteo Bini ◽

Umberto Camaiora ◽

Paolo Castiglioni ◽

Luca Moderato ◽

...

Keyword(s):

Uric Acid ◽

Confidence Interval ◽

Serum Uric Acid ◽

Acid Level ◽

Serum Uric Acid Level ◽

Myocardial Revascularization ◽

Valve Surgery ◽

Cardiac Valve ◽

Cardiac Valve Surgery ◽

Cerebrovascular Events

Background High levels of serum uric acid have been associated with adverse outcomes in cardiovascular diseases such as myocardial infarction and heart failure. The aim of the current study was to evaluate the prognostic role of serum uric acid levels in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. Design We performed an observational prospective cohort study. Methods The study included 1440 patients with available serum uric acid levels, prospectively followed for 50 ± 17 months. Mean age was 67 ± 11 years; 781 patients (54%) underwent myocardial revascularization, 474 (33%) cardiac valve surgery and 185 (13%) valve-plus-coronary artery by-pass graft surgery. The primary endpoints were overall and cardiovascular mortality while secondary end-points were combined major adverse cardiac and cerebrovascular events. Results Serum uric acid level mean values were 286 ± 95 µmol/l and elevated serum uric acid levels (≥360 µmol/l or 6 mg/dl) were found in 275 patients (19%). Overall mortality (hazard ratio = 2.1; 95% confidence interval: 1.5–3.0; p < 0.001), cardiovascular mortality (hazard ratio = 2.0; 95% confidence interval: 1.2–3.2; p = 0.004) and major adverse cardiac and cerebrovascular events rate (hazard ratio = 1.5; 95% confidence interval: 1.0–2.0; p = 0.019) were significantly higher in patients with elevated serum uric acid levels, even after adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate, atrial fibrillation and medical therapy. Moreover, strong positive correlations between serum uric acid level and probability of overall mortality ( p < 0.001), cardiovascular mortality ( p < 0.001) and major adverse cardiac and cerebrovascular events ( p = 0.003) were found. Conclusions Serum uric acid levels predict mortality and adverse cardiovascular outcome in patients undergoing myocardial revascularization and/or cardiac valve surgery even after the adjustment for age, gender, arterial hypertension, diabetes, glomerular filtration rate and medical therapy.

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