红细胞分布宽度与非瓣膜性心房颤动患者发生射血分数降低性心力衰竭的关系

Relationship between red blood cell distribution width and heart failure with a reduced ejection fraction in patients with non-valvular atrial fibrillation

目的分析红细胞分布宽度(red blood cell distribution width,RDW)与非瓣膜性心房颤动(non-valvular atrial fibrillation,NVAF)患者发生射血分数降低性心力衰竭(heart failure with reduced ejection fraction,HFrEF)的关系。方法回顾性分析山东省滕州市中心人民医院2016年1月-2020年12月收治的7381例NVAF患者的临床资料。按照是否存在HFrEF把NVAF患者分为非HFrEF组(n=6605)和HFrEF组(n=776),比较两组患者RDW水平,采用多因素logistic回归分析RDW是否为NVAF患者发生HFrEF的独立影响因素,通过受试者工作特性曲线及曲线下面积评估RDW对于判断HFrEF发生的价值。结果非HFrEF组和HFrEF组房颤分类、RDW、血肌酐比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,RDW、血肌酐是NVAF患者发生HFrEF的独立预测因素(OR值分别为3.08、1.03,P<0.05),持续性房颤、长期持续性房颤及永久性房颤发生射血分数降低性心力衰竭的概率是阵发性房颤的3.90及4.06倍(P<0.05)。RDW曲线下面积为0.76(95%CI 0.74~0.78,P=0.001),最大约登指数是14.01%,判断HFrEF的敏感度为55.8%、特异度为87.8%。结论在NVAF患者中,RDW水平与HFrEF独立相关,RDW水平对于判断HFrEF有一定参考价值。

Objective To determine the correlation between the red blood cell distribution width(RDW)and heart failure with a reduced ejection fraction(HFrEF)in patients with non-valvular atrial fibrillation(NVAF).Methods A total of 7381 patients with NVAF were recruited from Tengzhou Central People’s Hospital of Shandong Province from January 2016 to December 2020.Patients with atrial fibrillation were divided into non-HFrEF(n=6605)and HFrEF groups(n=776)based on the absence or presence of heart failure,respectively.The RDW level was compared between the two groups.The potential association between the RDW and HFrEF was analyzed using multivariate logistic regression analysis.The accuracy of RDW in detecting HFrEF was determined by receiver operating characteristic(ROC)curve analysis.Results There were significant differences between the two groups as a function of atrial fibrillation,RDW,and serum creatinine level(P<0.05).Multivariate logistic regression analysis showed that the RDW and serum creatinine level were independent predictors of HFrEF in patients with NVAF(OR values were 3.08,1.03,respectively,P<0.05).HFrEF in patients with persistent atrial fibrillation,long-term persistent atrial fibrillation,and permanent atrial fibrillation was 3.90 and 4.06 times higher than patients with paroxysmal atrial fibrillation(P<0.05).The area under the RDW curve was 0.76(95%CI 0.74~0.78,P=0.001).ROC analysis of the RDW showed that the maximum Jordan index was 14.01%,and the sensitivity and specificity for detecting HFrEF were 55.8%and 87.8%,respectively.Conclusions The RDW is associated with the presence of HFrEF inpatients with NVAF.The RDW level can serve as a reference value for predicting HFrEF.