Red Cell Distribution Width with CHADS2 and CHA2DS2-VASc score is associated with Post-operative Atrial Fibrillation after Coronary Artery Bypass Grafting
DOI:
https://doi.org/10.1532/hsf.1886Keywords:
CABG, post-operative atrial fibrillation, red cell distribution widthAbstract
Background: The use of the CHA2DS2-VASc scoring system and red cell distribution width (RDW) as post-op Atrial Fibrillation (POAF) predictors may be promising for the identification of patients that are at a higher risk of POAF.
Methods: A total of 358 patients (57 patients with POAF, and 301 patients with non-POAF ) with sinus rhythm undergoing a coronary artery bypass graft (CABG) operation were included in the study retrospectively. Preoperative RDW levels and electrocardiograms with sinus rhythm were recorded. Patients with at least one 12-lead electrocardiogram with atrial fibrillation in the postoperative period, with or without medical or electrical cardioversion, were considered to have postoperative atrial fibrillation. A CHADS2 and CHA2DS2-VASc score was calculated for all of the patients.
Results: RDW levels were significantly higher in POAF group. RDW levels were significantly correlated with CHADS2 ( r = 0.15, P = .007) and CHA2DS2-VASc (r = 0.19 P = .0001) scores. CHA2DS2-VASc scores were significantly higher in patients with POAF, whereas CHADS2 scores did not differ between groups. In multivariate analysis, left atrial diameter (LAD) (OR:2.44 [95% CI 1.16 – 5.1], P = .018), age (OR:1.04 [95% CI 1.01 – 1.08], P = .01), and RDW (OR:1.16 [95% CI 1.0 – 1.36], P = .05) were found to be predictive for POAF. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.57 – 0.72, P = .0001) with 68.4% sensitivity and 51.2 % specificity to predict POAF.
Conclusion: Our study showed that age, LAD, and the reduced probability of RDW are predictors of POAF, and that RDW is strongly associated with the thromboembolic risk as determined by CHADS2 and CHA2DS2-VASc scores.
References
Anatoĺevna RO, Veniaminovich FO, Mikhaylovich KS. 2016. Predictors of new-onset atrial fibrillation in elderly patients with coronary artery disease after coronary artery bypass graft. J Geriatr Cardiol 13:444-9.
Ani C, Ovbiagele B. 2009. Elevated red blood cell distribution width predicts mortality in persons with known stroke. J Neurol Sci 277:103-8.
Ashes CM, Yu M, Meineri M, et al. 2014. Diastolic dysfunction, cardiopulmonary bypass, and atrial fibrillation after coronary artery bypass graft surgery. Br J Anaesth 113:815-21.
Aviles RJ, Martin DO, Apperson-Hansen C, et al. 2003. Inflammation as a risk factor for atrial fibrillation. Circulation 108:3006-10.
Azab B, Torbey E, Hatoum H, et al. 2011. Usefulness of red cell distribution width in predicting all-cause long-term mortality after non-ST-elevation myocardial infarction. Cardiology 119:72-80.
Bohatch Júnior MS, Matkovski PD, Di Giovanni FJ, et al. 2015. Incidence of postoperative atrial fibrillation in patients undergoing on-pump and off-pump coronary artery bypass grafting. Rev Bras Cir Cardiovasc 30:316-24.
Chua SK, Shyu KG, Lu MJ, et al. 2013. Clinical utility of CHADS2 and CHA2DS2-VASc scoring systems for predicting postoperative atrial fibrillation after cardiac surgery. J Thorac Cardiovasc Surg 146:919-26.
Danese E, Lippi G, Montagnana M. 2015. Red blood cell distribution width and cardiovascular diseases. J Thorac Dis 7:E402-11.
Ertaş G, Aydin C, Sönmez O, et al. 2013. Red cell distribution width predicts new-onset atrial fibrillation after coronary artery bypass grafting. Scand Cardiovasc J 47:132-5.
European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, et al. 2010. Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the european society of cardiology (ESC). Eur Heart J 31:2369-429.
Folla CO, Melo CC, Silva RC. 2016. Predictive factors of atrial fibrillation after coronary artery bypass grafting. Einstein (Sao Paulo) 14:480-5.
Gabrielli L, Corbalan R, Córdova S, et al. 2011. Left atrial dysfunction is a predictor of postcoronary artery bypass atrial fibrillation: association of left atrial strain and strain rate assessed by speckle tracking. Echocardiography 28:1104-8.
Güngör B, Özcan KS, Erdinler İ, et al. 2014. Elevated levels of RDW is associated with non-valvular atrial fibrillation. J Thromb Thrombolysis 37:404-10.
Korantzopoulos P, Sontis N, Liu T, et al. 2015. Association between red blood cell distribution width and postoperative atrial fibrillation after cardiac surgery: a pilot observational study. Int J Cardiol 185:19-21.
Kurt M, Tanboga IH, Buyukkaya E, et al. 2014. Relation of red cell distribution width with CHA2DS2-VASc score in patients with nonvalvular atrial fibrillation. Clin Appl Thromb Hemost 20:687-92.
Lee KH, Park HW, Cho JG, et al. 2015. Red cell distribution width as a novel predictor for clinical outcomes in patients with paroxysmal atrial fibrillation. Europace 17 Suppl 2:ii83-8.
Liu T, Shao Q, Korantzopoulos P et al. 2017. Relation of red blood cell distribution width with CHADS2 and CHA2DS2-VASc score in Chinese patients with non-valvular atrial fibrillation. Int J Cardiol 228:861-864.
Makhoul BF, Khourieh A, Kaplan M, et al. 2013. Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol 167:1412-6.
Mansoor E. 2014. De novo atrial fibrillation post cardiac surgery: the Durban experience. Cardiovasc J Afr 25:282-7.
Onk OA, Erkut B. 2015. Is the preoperative administration of amiodarone or metoprolol more effective in reducing atrial fibrillation: after coronary bypass surgery? Medicine (Baltimore). 94:e1576.
Saliba W, Barnett-Griness O, Rennert G. 2017. Red cell distribution width and all-cause mortality in patients with atrial fibrillation: a cohort study. J Arrhythm 33:56-62.
Sánchez-Chaparro MA, Calvo-Bonacho E, González-Quintela A, et al. 2010. Higher red blood cell distribution width is associated with the metabolic syndrome: results of the ibermutuamur cardiovascular risk assessment study. Diabetes Care 33:e40.
Şaşkın H, Düzyol Ç, Aksoy R, et al. 2016. Do preoperative C-reactive protein and mean platelet volume levels predict development of postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting? Postepy Kardiol Interwencyjnej 12:156-63.
Staerk L, Sherer JA, Ko D, et al. 2017. Atrial fibrillation: epidemiology, pathophysiology, and clinical outcomes. Circ Res 120:1501-17.
Tanindi A, Topal FE, Topal F, et al. 2012. Red cell distribution width in patients with prehypertension and hypertension.Blood Press 21:177-81.
Villareal RP, Hariharan R, Liu BC, et al. 2004. Postoperative atrial fibrillation and mortality after coronary artery bypass surgery. J Am Coll Cardiol 43:742-8.
Yadava M, Hughey AB, Crawford TC. 2016. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Heart Fail Clin 12:299-308.
