International Journal of Cardiology 179 (2015) 201–202
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Mean platelet volume provides an additive value in differentiating congestive heart failure from chronic obstructive pulmonary disease Ruitao Wang a, Zhigang Cao b, Ying Li a,c, Kaijiang Yu d,⁎ a
Department of Geriatrics, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China Department of Interventional Radiology, the Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China International Physical Examination and Healthy Center, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China d Department of Intensive Care Unit, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China b c
a r t i c l e
i n f o
Article history: Received 5 November 2014 Accepted 6 November 2014 Available online 7 November 2014 Keywords: Congestive heart failure Chronic obstructive pulmonary disease N-terminal pro B-type natriuretic peptide Mean platelet volume
To the Editor, We thank Ercan et al. for their comments and appreciate their interest in our study [1,2]. They raise several points, which we address below. Acute congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have considerable comorbidities, making it a challenge to differentiate between these two distinct diseases [3]. Previous studies have reported that N-terminal pro B-type natriuretic peptide (NT-pro BNP) is a good indicator in identifying patients with CHF [4]. However, NT-pro BNP is also elevated in COPD patients. Our study found that mean platelet volume (MPV) could provide an additive value in differentiating CHF from COPD. MPV values could be influenced by diabetes mellitus, hypertension, obesity, coronary artery disease (CAD), metabolic syndrome, blood lipid, and atrial fibrillation. There were no patients with atrial fibrillation in our study due to medical treatment with anticoagulant or antiplatelet. We provided the data about fasting plasma glucose, blood pressure, blood lipid, CAD, and metabolic syndrome in Table 1. The results showed that systolic blood pressure, diastolic ⁎ Corresponding author at: Department of Intensive Care Unit, The Second Affiliated Hospital, Harbin Medical University, NO. 246 Xuefu ST, Nangang District, Harbin 150086, China. E-mail address: [email protected] (K. Yu).
http://dx.doi.org/10.1016/j.ijcard.2014.11.078 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, and the prevalence of CAD and metabolic syndrome had a significant difference in four groups. However, triglyceride had no difference in four groups. There was a positive correlation between MPV and Creactive protein (CRP) after adjusting confounding factors (r = − 0.227, p b 0.001). The risk factors found to be significantly associated with differentiation of CHF and COPD in logistic regression analysis included MPV, lower extremity edema, CAD, orthopnea, and NTpro BNP. In addition, receiver operating characteristic (ROC) curve analysis showed that inclusion of MPV elevated the sensitivity and decreased the specificity, indicating that more CHF patients were correctly diagnosed. The combination of both markers exhibited a significantly larger area under curve (AUC) of 0.970 (0.951; 0.990) compared with NT-pro BNP or MPV alone (p b 0.001), suggesting that MPV provides an additive value for differentiation beyond the NT-pro BNP alone (Fig. 1). The data suggest that NT-pro BNP and MPV have complementary diagnostic values in differentiating CHF from COPD. MPV provides an additive value for differentiation beyond the NT-pro BNP alone with respect to improved sensitivity, negative predictive value and AUC. Furthermore, the combination of NT-pro BNP and MPV has similar specificity and positive predictive value compared to NT-pro BNP alone. Our research indicated that a combination of NT-pro BNP and MPV could assist clinicians in distinguishing CHF from COPD. Recent studies have presented that MPV is an inflammatory indicator in different diseases [5]. Low levels of MPV are associated with high-grade inflammatory diseases and high levels of MPV are associated with low-grade inflammatory diseases. Our study confirmed that MPV is negatively correlated with CRP levels after adjusting other confounding factors. Various studies have suggested that chronic low-grade systemic inflammation, oxidative stress and increased platelet activation are implicated in the mechanism of CAD in patients with COPD [6]. A meta-analysis revealed that MPV was significantly larger in patients with CAD than controls [7]. Moreover, MPV levels are decreased in COPD [8,9]. Recently, a report documented that MPV is a predictive marker for cardiac death after percutaneous coronary intervention in patients with heart failure [10]. Therefore, the use of MPV confers additional benefit to diagnostic accuracy in differentiating acute CHF from COPD.
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R. Wang et al. / International Journal of Cardiology 179 (2015) 201–202
Table 1 Clinical and demographic characteristics of subjects. Variables
CHF
COPD
CHF + COPD
Control
p-Value
Number BMI (kg/m2) SBP (mm Hg) DBP (mm Hg) TC (mmol/L) TG (mmol/L) HDL (mmol/L) LDL (mmol/L) FPG (mmol/L) Hypertension (n, %) Metabolic syndrome (n, %) CAD (n, %)
80 25.5 ± 2.9 140.6 ± 11.3 78.8 ± 6.5 4.32 ± 1.12 1.66 (1.10–2.39) 0.90 (0.80–0.99) 2.94 ± 1.18 6.96 (6.35–8.00) 38 (48) 68 (85) 52 (65)
80 24.9 ± 2.6 132.8 ± 7.3 76.4 ± 6.4 3.65 ± 0.82 1.46 (1.23–2.05) 0.98 (0.80–1.10) 2.57 ± 0.79 6.07 (5.36–6.94) 21 (26) 46 (58) 26 (33)
80 25.3 ± 2.8 139.4 ± 8.9 79.8 ± 6.5 3.76 ± 0.87 1.49 (1.36–1.68) 0.97 (0.85–1.03) 2.80 ± 0.85 6.15 (5.59–7.26) 36 (45) 60 (75) 58 (73)
80 25.2 ± 3.5 136.7 ± 8.5 77.5 ± 6.9 3.43 ± 0.86 1.40 (1.08–1.81) 1.01 (0.80–1.21) 2.38 ± 0.66 5.31 (4.97–5.97) 29 (36) 41 (51) 10 (13)
0.638 b0.001 b0.001 b0.001 0.207 0.010 b0.001 b0.001 0.025 b0.001 b0.001
Data are expressed as means (SD), median (IQR = interquartile range) or percentage. CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; FPG, fasting plasma glucose, CAD, coronary artery disease. p-Value was calculated by one-way ANOVA test or Kruskal–Wallis H test or chi-square test.
Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] R. Wang, Z. Cao, Y. Li, K. Yu, Utility of N-terminal pro B-type natriuretic peptide and mean platelet volume in differentiating congestive heart failure from chronic obstructive pulmonary disease, Int. J. Cardiol. 170 (2) (2013) e28–e29. [2] E. Varol, M. Ozaydin, Mean platelet volume in differentiating congestive heart failure from chronic obstructive pulmonary disease, Int. J. Cardiol. 172 (2) (2014) e299. [3] N.M. Hawkins, P.S. Jhund, C.R. Simpson, et al., Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland, Eur. J. Heart Fail. 12 (1) (2010) 17–24. [4] A.S. Maisel, P. Krishnaswamy, R.M. Nowak, et al., Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure, N. Engl. J. Med. 347 (3) (2002) 161–167.
Fig. 1. ROC curves for NT-pro BNP or MPV or their combination for discrimination of CHF from COPD. CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; MPV, mean platelet volume; NT-pro BNP, N-terminal pro B-type natriuretic peptide.
[5] S.G. Chu, R.C. Becker, P.B. Berger, et al., Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis, J. Thromb. Haemost. 8 (1) (2010) 148–156. [6] K. Ghoorah, A. De Soyza, V. Kunadian, Increased cardiovascular risk in patients with chronic obstructive pulmonary disease and the potential mechanisms linking the two conditions: a review, Cardiol. Rev. 21 (4) (2013) 196–202. [7] N. Sansanayudh, T. Anothaisintawee, D. Muntham, M. McEvoy, J. Attia, Ammarin Thakkinstian, Mean platelet volume and coronary artery disease: a systematic review and meta-analysis, Int. J. Cardiol. 175 (3) (2014) 433–440. [8] V.R. Biljak, D. Pancirov, I. Cepelak, S. Popovic-Grle, G. Stjepanovic, T.Z. Grubisic, Platelet count, mean platelet volume and smoking status in stable chronic obstructive pulmonary disease, Platelets 22 (6) (2011) 466–470. [9] R.T. Wang, J.Y. Li, Z.G. Cao, Y. Li, Mean platelet volume is decreased during an acute exacerbation of chronic obstructive pulmonary disease, Respirology 18 (8) (2013) 1244–1248. [10] Y.J. Ki, S. Park, S.I. Ha, D.H. Choi, H. Song, Usefulness of mean platelet volume as a biomarker for long-term clinical outcomes after percutaneous coronary intervention in Korean cohort: a comparable and additive predictive value to highsensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide, Platelets 25 (6) (2014) 427–432.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Letter to the Editor
Mean platelet volume provides an additive value in differentiating congestive heart failure from chronic obstructive pulmonary disease Ruitao Wang a, Zhigang Cao b, Ying Li a,c, Kaijiang Yu d,⁎ a
Department of Geriatrics, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China Department of Interventional Radiology, the Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China International Physical Examination and Healthy Center, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China d Department of Intensive Care Unit, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China b c
a r t i c l e
i n f o
Article history: Received 5 November 2014 Accepted 6 November 2014 Available online 7 November 2014 Keywords: Congestive heart failure Chronic obstructive pulmonary disease N-terminal pro B-type natriuretic peptide Mean platelet volume
To the Editor, We thank Ercan et al. for their comments and appreciate their interest in our study [1,2]. They raise several points, which we address below. Acute congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD) have considerable comorbidities, making it a challenge to differentiate between these two distinct diseases [3]. Previous studies have reported that N-terminal pro B-type natriuretic peptide (NT-pro BNP) is a good indicator in identifying patients with CHF [4]. However, NT-pro BNP is also elevated in COPD patients. Our study found that mean platelet volume (MPV) could provide an additive value in differentiating CHF from COPD. MPV values could be influenced by diabetes mellitus, hypertension, obesity, coronary artery disease (CAD), metabolic syndrome, blood lipid, and atrial fibrillation. There were no patients with atrial fibrillation in our study due to medical treatment with anticoagulant or antiplatelet. We provided the data about fasting plasma glucose, blood pressure, blood lipid, CAD, and metabolic syndrome in Table 1. The results showed that systolic blood pressure, diastolic ⁎ Corresponding author at: Department of Intensive Care Unit, The Second Affiliated Hospital, Harbin Medical University, NO. 246 Xuefu ST, Nangang District, Harbin 150086, China. E-mail address: [email protected] (K. Yu).
http://dx.doi.org/10.1016/j.ijcard.2014.11.078 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fasting plasma glucose, and the prevalence of CAD and metabolic syndrome had a significant difference in four groups. However, triglyceride had no difference in four groups. There was a positive correlation between MPV and Creactive protein (CRP) after adjusting confounding factors (r = − 0.227, p b 0.001). The risk factors found to be significantly associated with differentiation of CHF and COPD in logistic regression analysis included MPV, lower extremity edema, CAD, orthopnea, and NTpro BNP. In addition, receiver operating characteristic (ROC) curve analysis showed that inclusion of MPV elevated the sensitivity and decreased the specificity, indicating that more CHF patients were correctly diagnosed. The combination of both markers exhibited a significantly larger area under curve (AUC) of 0.970 (0.951; 0.990) compared with NT-pro BNP or MPV alone (p b 0.001), suggesting that MPV provides an additive value for differentiation beyond the NT-pro BNP alone (Fig. 1). The data suggest that NT-pro BNP and MPV have complementary diagnostic values in differentiating CHF from COPD. MPV provides an additive value for differentiation beyond the NT-pro BNP alone with respect to improved sensitivity, negative predictive value and AUC. Furthermore, the combination of NT-pro BNP and MPV has similar specificity and positive predictive value compared to NT-pro BNP alone. Our research indicated that a combination of NT-pro BNP and MPV could assist clinicians in distinguishing CHF from COPD. Recent studies have presented that MPV is an inflammatory indicator in different diseases [5]. Low levels of MPV are associated with high-grade inflammatory diseases and high levels of MPV are associated with low-grade inflammatory diseases. Our study confirmed that MPV is negatively correlated with CRP levels after adjusting other confounding factors. Various studies have suggested that chronic low-grade systemic inflammation, oxidative stress and increased platelet activation are implicated in the mechanism of CAD in patients with COPD [6]. A meta-analysis revealed that MPV was significantly larger in patients with CAD than controls [7]. Moreover, MPV levels are decreased in COPD [8,9]. Recently, a report documented that MPV is a predictive marker for cardiac death after percutaneous coronary intervention in patients with heart failure [10]. Therefore, the use of MPV confers additional benefit to diagnostic accuracy in differentiating acute CHF from COPD.
202
R. Wang et al. / International Journal of Cardiology 179 (2015) 201–202
Table 1 Clinical and demographic characteristics of subjects. Variables
CHF
COPD
CHF + COPD
Control
p-Value
Number BMI (kg/m2) SBP (mm Hg) DBP (mm Hg) TC (mmol/L) TG (mmol/L) HDL (mmol/L) LDL (mmol/L) FPG (mmol/L) Hypertension (n, %) Metabolic syndrome (n, %) CAD (n, %)
80 25.5 ± 2.9 140.6 ± 11.3 78.8 ± 6.5 4.32 ± 1.12 1.66 (1.10–2.39) 0.90 (0.80–0.99) 2.94 ± 1.18 6.96 (6.35–8.00) 38 (48) 68 (85) 52 (65)
80 24.9 ± 2.6 132.8 ± 7.3 76.4 ± 6.4 3.65 ± 0.82 1.46 (1.23–2.05) 0.98 (0.80–1.10) 2.57 ± 0.79 6.07 (5.36–6.94) 21 (26) 46 (58) 26 (33)
80 25.3 ± 2.8 139.4 ± 8.9 79.8 ± 6.5 3.76 ± 0.87 1.49 (1.36–1.68) 0.97 (0.85–1.03) 2.80 ± 0.85 6.15 (5.59–7.26) 36 (45) 60 (75) 58 (73)
80 25.2 ± 3.5 136.7 ± 8.5 77.5 ± 6.9 3.43 ± 0.86 1.40 (1.08–1.81) 1.01 (0.80–1.21) 2.38 ± 0.66 5.31 (4.97–5.97) 29 (36) 41 (51) 10 (13)
0.638 b0.001 b0.001 b0.001 0.207 0.010 b0.001 b0.001 0.025 b0.001 b0.001
Data are expressed as means (SD), median (IQR = interquartile range) or percentage. CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; BMI, body mass index; SBP, systolic blood pressure; DBP, diastolic blood pressure; TC, total cholesterol; TG, triglyceride; HDL, high-density lipoprotein cholesterol; LDL, low-density lipoprotein cholesterol; FPG, fasting plasma glucose, CAD, coronary artery disease. p-Value was calculated by one-way ANOVA test or Kruskal–Wallis H test or chi-square test.
Conflict of interest The authors report no relationships that could be construed as a conflict of interest. References [1] R. Wang, Z. Cao, Y. Li, K. Yu, Utility of N-terminal pro B-type natriuretic peptide and mean platelet volume in differentiating congestive heart failure from chronic obstructive pulmonary disease, Int. J. Cardiol. 170 (2) (2013) e28–e29. [2] E. Varol, M. Ozaydin, Mean platelet volume in differentiating congestive heart failure from chronic obstructive pulmonary disease, Int. J. Cardiol. 172 (2) (2014) e299. [3] N.M. Hawkins, P.S. Jhund, C.R. Simpson, et al., Primary care burden and treatment of patients with heart failure and chronic obstructive pulmonary disease in Scotland, Eur. J. Heart Fail. 12 (1) (2010) 17–24. [4] A.S. Maisel, P. Krishnaswamy, R.M. Nowak, et al., Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure, N. Engl. J. Med. 347 (3) (2002) 161–167.
Fig. 1. ROC curves for NT-pro BNP or MPV or their combination for discrimination of CHF from COPD. CHF, congestive heart failure; COPD, chronic obstructive pulmonary disease; MPV, mean platelet volume; NT-pro BNP, N-terminal pro B-type natriuretic peptide.
[5] S.G. Chu, R.C. Becker, P.B. Berger, et al., Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis, J. Thromb. Haemost. 8 (1) (2010) 148–156. [6] K. Ghoorah, A. De Soyza, V. Kunadian, Increased cardiovascular risk in patients with chronic obstructive pulmonary disease and the potential mechanisms linking the two conditions: a review, Cardiol. Rev. 21 (4) (2013) 196–202. [7] N. Sansanayudh, T. Anothaisintawee, D. Muntham, M. McEvoy, J. Attia, Ammarin Thakkinstian, Mean platelet volume and coronary artery disease: a systematic review and meta-analysis, Int. J. Cardiol. 175 (3) (2014) 433–440. [8] V.R. Biljak, D. Pancirov, I. Cepelak, S. Popovic-Grle, G. Stjepanovic, T.Z. Grubisic, Platelet count, mean platelet volume and smoking status in stable chronic obstructive pulmonary disease, Platelets 22 (6) (2011) 466–470. [9] R.T. Wang, J.Y. Li, Z.G. Cao, Y. Li, Mean platelet volume is decreased during an acute exacerbation of chronic obstructive pulmonary disease, Respirology 18 (8) (2013) 1244–1248. [10] Y.J. Ki, S. Park, S.I. Ha, D.H. Choi, H. Song, Usefulness of mean platelet volume as a biomarker for long-term clinical outcomes after percutaneous coronary intervention in Korean cohort: a comparable and additive predictive value to highsensitivity cardiac troponin T and N-terminal pro-B type natriuretic peptide, Platelets 25 (6) (2014) 427–432.
