[II-AEPCYIA-2] Red blood cell distribution width and Platelet distribution width as novel biomarkers for Fontan hemodynamics and associated end organ damage
BACKGROUND AND AIM:Circulating blood cell count and cellular size are under homeostasis of biosystem. Red blood cell distribution width (RDW) and platelet cell distribution width (PDW) are known as surrogate markers for heart failure and microcirculation, respectively. Since the venous congestion coupled with reduced cardiac output are the common features of Fontan circulation and heart failure, RDW and PDW could be the marker for Fontan Failure. We tested our hypothesis that the RDW and PDW are the biological marker for Fontan circulation and related organ dysfunction.
METHOD:The consecutive 134 patients with Fontan circulation who were performed cardiac catheterization were enrolled in this study. The relationships between RDW, PDW and hemodynamic index as well as markers for heart failure, and end organ dysfunction was analyzed.
RESULTS:RDW was positively correlated with central venous pressure (p<0.001) and pulmonary wedge pressure (p=0.002), suggesting unfavorable Fontan hemodynamics. Although higher cardiac index and lower systemic vascular resistance were also correlated with higher RDW, it was considered as the result of vasodilation often observed in the unfavorable Fontan circulation, since RDW was closely correlated with elevated serum levels of procollagen type III peptide(p=0.0024), type IV collagen 7s (p=0.001), the markers for hepatic fibrogenesis, even after adjusting for age. In sharp contrast with the RDW, PDW was independent of age, hemodynamic index and natriuretic peptides, but was positively correlated with liver fibrosis index Fib-4 index (p<0.001), total bilirubin (p=0.023), and albumin/IgG ratio. (p=0.0085). Interestingly, PDW was positively correlated with hepatic venous oxygen saturation (p=0.0054) and serum manganese level (p=0.027), and negatively correlated with hepatic venous wedge pressure (p=0.022), indicating that PDW was likely to be associated with resultant progression of portosystemic shunt originating from hepatic fibrosis.
CONCLUSIONS:RDW reflected venous congestion and related fibrogenesis in the Fontan patients. In sharp contrast, PDW appeared to have indicated Fontan related liver dysfunction. The pathologic interaction among PDW, platelet production and hepatic dysfunction needs to be elucidated in the future.
METHOD:The consecutive 134 patients with Fontan circulation who were performed cardiac catheterization were enrolled in this study. The relationships between RDW, PDW and hemodynamic index as well as markers for heart failure, and end organ dysfunction was analyzed.
RESULTS:RDW was positively correlated with central venous pressure (p<0.001) and pulmonary wedge pressure (p=0.002), suggesting unfavorable Fontan hemodynamics. Although higher cardiac index and lower systemic vascular resistance were also correlated with higher RDW, it was considered as the result of vasodilation often observed in the unfavorable Fontan circulation, since RDW was closely correlated with elevated serum levels of procollagen type III peptide(p=0.0024), type IV collagen 7s (p=0.001), the markers for hepatic fibrogenesis, even after adjusting for age. In sharp contrast with the RDW, PDW was independent of age, hemodynamic index and natriuretic peptides, but was positively correlated with liver fibrosis index Fib-4 index (p<0.001), total bilirubin (p=0.023), and albumin/IgG ratio. (p=0.0085). Interestingly, PDW was positively correlated with hepatic venous oxygen saturation (p=0.0054) and serum manganese level (p=0.027), and negatively correlated with hepatic venous wedge pressure (p=0.022), indicating that PDW was likely to be associated with resultant progression of portosystemic shunt originating from hepatic fibrosis.
CONCLUSIONS:RDW reflected venous congestion and related fibrogenesis in the Fontan patients. In sharp contrast, PDW appeared to have indicated Fontan related liver dysfunction. The pathologic interaction among PDW, platelet production and hepatic dysfunction needs to be elucidated in the future.