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Red cell distribution width as a predictor of left atrial spontaneous echo contrast in echocardiography.

Gerede DM, Kaya CT, Vurgun VK, Acıbuca A, Tak BT, Ongun A, Kılıckap M, Erol C - Medicine (Baltimore) (2015)

Bottom Line: The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups.The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001).When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey.

ABSTRACT
Red cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC). One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups. The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001). In the ROC analysis, an RDW level >13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve = 0.834, P < 0.0001, 95% CI 0.656-0.773). In multivariate analysis, RDW levels >13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198-2.085; P = 0.001 and OR 1.586; 95% CI 1.195-2.098; P = 0.003, respectively]. Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC.

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Transesophageal echocardiogram showing a left atrial appendage without spontaneous echo contrast in a patient.
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Figure 1: Transesophageal echocardiogram showing a left atrial appendage without spontaneous echo contrast in a patient.

Mentions: TEE was performed in all patients using a 5 MHz biplane phased array transducer (Vivid S5, GE, Horten, Norway) by the same examiner, who was blinded to the laboratory details. The left atrial appendage emptying peak flow velocity (LAAV) was measured with pulsed Doppler by placing the sample volume 1 cm into the mouth of the LAA. The mean LAAV was determined by averaging 5 consecutive cardiac cycles. The LA and LAA were evaluated for thrombus and SEC, which was graded from 0 (none) to 4 (severe) according to previously described criteria.13 It was graded as 0 = none (absence of echogenicity); 1 = mild (minimal echogenicity located in the LAA or rarely in the main cavity of the LA); 2 = mild to moderate (more dense swirling pattern than grade 1 but with similar distribution); 3 = moderate (dense swirling pattern in the LAA, less intense in the main LA cavity, may fluctuate in intensity but constantly detectable throughout the cardiac cycle); and 4 = severe (intense echo density and very slow swirling pattern in the LAA and with similar intensity in the main LA cavity) (Figures 1 and 2).


Red cell distribution width as a predictor of left atrial spontaneous echo contrast in echocardiography.

Gerede DM, Kaya CT, Vurgun VK, Acıbuca A, Tak BT, Ongun A, Kılıckap M, Erol C - Medicine (Baltimore) (2015)

Transesophageal echocardiogram showing a left atrial appendage without spontaneous echo contrast in a patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4554040&req=5

Figure 1: Transesophageal echocardiogram showing a left atrial appendage without spontaneous echo contrast in a patient.
Mentions: TEE was performed in all patients using a 5 MHz biplane phased array transducer (Vivid S5, GE, Horten, Norway) by the same examiner, who was blinded to the laboratory details. The left atrial appendage emptying peak flow velocity (LAAV) was measured with pulsed Doppler by placing the sample volume 1 cm into the mouth of the LAA. The mean LAAV was determined by averaging 5 consecutive cardiac cycles. The LA and LAA were evaluated for thrombus and SEC, which was graded from 0 (none) to 4 (severe) according to previously described criteria.13 It was graded as 0 = none (absence of echogenicity); 1 = mild (minimal echogenicity located in the LAA or rarely in the main cavity of the LA); 2 = mild to moderate (more dense swirling pattern than grade 1 but with similar distribution); 3 = moderate (dense swirling pattern in the LAA, less intense in the main LA cavity, may fluctuate in intensity but constantly detectable throughout the cardiac cycle); and 4 = severe (intense echo density and very slow swirling pattern in the LAA and with similar intensity in the main LA cavity) (Figures 1 and 2).

Bottom Line: The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups.The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001).When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001).

View Article: PubMed Central - PubMed

Affiliation: From the Department of Cardiology, Ankara University School of Medicine, Ankara, Turkey.

ABSTRACT
Red cell distribution width (RDW) represents the heterogeneity of red blood cells (anisocytosis). Spontaneous echo contrast (SEC) is thought to be a manifestation of red cell aggregation and it has been linked to the development of thromboemboli. The aim of this study was to evaluate the association between RDW levels and the presence of left atrial SEC (LASEC). One-hundred and 72 patients who underwent transesophageal echocardiography for various indications were enrolled in the study. All patients were categorized into 2 groups according to the presence of LASEC and into 4 groups according to the severity of LASEC. The baseline clinical characteristics, echocardiographic measurements, and laboratory findings, including RDW, were compared between the groups. The RDW (%) level was higher in the LASEC group (14.95 ± 1.32) compared with the non-LASEC group (12.20 ± 1.45; P = 0.0001). When the relationship between RDW and SEC was evaluated according to the increasing grade of SEC, a significant positive correlation was found (r = 0.645, P < 0.0001). In the ROC analysis, an RDW level >13.8% had 70% sensitivity and 89.2% specificity in predicting LASEC (area under the curve = 0.834, P < 0.0001, 95% CI 0.656-0.773). In multivariate analysis, RDW levels >13.8% and the presence of atrial fibrillation were independently associated with LASEC (odds ratio [OR] 1.697; 95% confidence interval [CI] 1.198-2.085; P = 0.001 and OR 1.586; 95% CI 1.195-2.098; P = 0.003, respectively]. Elevated RDW value is associated with the presence and the severity of SEC. RDW may be a useful marker and independent predictor for the presence of SEC.

Show MeSH
Related in: MedlinePlus