Am J Cardiovasc Dis 2013;3(2):91-102
Original Article
Mean corpuscular volume and red cell distribution width as predictors of left
atrial stasis in patients with non-valvular atrial fibrillation
Rui Providência, Maria João Ferreira, Lino Gonçalves, Ana Faustino, Luís Paiva, Andreia Fernandes, Sérgio Barra, Joana
Pimenta, António M Leitão-Marques
Coimbra’s Hospital Centre and University, Cardiology Department, Coimbra, Portugal; University of Coimbra, Faculty of
Medicine, Coimbra, Portugal
Received March 27, 2013; Accepted May 3, 2013; Epub June 10, 2013; Published June 15, 2013
Abstract: Background: The role of erythrocyte indexes for the prediction of left atrial stasis, assessed by transesophageal
echocardiography in patients with non-valvular atrial fibrillation, has not been previously clarified. Methods: Single center
cross-sectional study comprising 247 consecutive patients admitted to the emergency department due to symptomatic
atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage
thrombus (LAAT) before cardioversion. All patients had a complete blood count performed up to 12 hours prior to the
transesophageal echocardiogram. Markers of left atrial stasis were sought: LAAT, dense spontaneous echocardiographic
contrast (DSEC) and low flow velocities (LFV) in the left atrial appendage. Erythrocyte indexes’ accuracy for detecting
transesophageal echocardiogram changes was evaluated through receiver operating curve analysis. Binary logistic
multivariate analysis, using solely erythrocyte indexes and in combination with other variables (i.e. CHADS2,
CHA2DS2VASc classifications and left ventricle ejection fraction), was used for transesophageal echocardiogram
endpoints prediction. Results: LAAT was found in 8.5%, DSEC in 26.1% and LFV in 12.1%. Mean corpuscular volume and
red cell distribution width were independent predictors of LAAT and DSEC. Despite adding incremental predictive value to
each other, when clinical risk factors from CHADS2 and CHA2DS2VASc classifications and left ventricle ejection fraction
were added to the models, only mean corpuscular volume remained an independent predictor of LAAT and DSEC.
Conclusions: These findings suggest that mean corpuscular volume and red cell distribution width may be linked to left
atrial stasis markers. (AJCD1303004).
Keywords: Atrial fibrillation, stroke, left atrial appendage thrombus, mean corpuscular volume, red cell distribution width,
spontaneous echocardiographic contrast
Address correspondence to: Rui Providência, Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra,
Quinta dos Vales, S. Martinho do Bispo, 3041-853 Coimbra, Portugal. Fax: +351239445737; E-mail:
rui_providencia@yahoo.com
Original Article
Mean corpuscular volume and red cell distribution width as predictors of left
atrial stasis in patients with non-valvular atrial fibrillation
Rui Providência, Maria João Ferreira, Lino Gonçalves, Ana Faustino, Luís Paiva, Andreia Fernandes, Sérgio Barra, Joana
Pimenta, António M Leitão-Marques
Coimbra’s Hospital Centre and University, Cardiology Department, Coimbra, Portugal; University of Coimbra, Faculty of
Medicine, Coimbra, Portugal
Received March 27, 2013; Accepted May 3, 2013; Epub June 10, 2013; Published June 15, 2013
Abstract: Background: The role of erythrocyte indexes for the prediction of left atrial stasis, assessed by transesophageal
echocardiography in patients with non-valvular atrial fibrillation, has not been previously clarified. Methods: Single center
cross-sectional study comprising 247 consecutive patients admitted to the emergency department due to symptomatic
atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage
thrombus (LAAT) before cardioversion. All patients had a complete blood count performed up to 12 hours prior to the
transesophageal echocardiogram. Markers of left atrial stasis were sought: LAAT, dense spontaneous echocardiographic
contrast (DSEC) and low flow velocities (LFV) in the left atrial appendage. Erythrocyte indexes’ accuracy for detecting
transesophageal echocardiogram changes was evaluated through receiver operating curve analysis. Binary logistic
multivariate analysis, using solely erythrocyte indexes and in combination with other variables (i.e. CHADS2,
CHA2DS2VASc classifications and left ventricle ejection fraction), was used for transesophageal echocardiogram
endpoints prediction. Results: LAAT was found in 8.5%, DSEC in 26.1% and LFV in 12.1%. Mean corpuscular volume and
red cell distribution width were independent predictors of LAAT and DSEC. Despite adding incremental predictive value to
each other, when clinical risk factors from CHADS2 and CHA2DS2VASc classifications and left ventricle ejection fraction
were added to the models, only mean corpuscular volume remained an independent predictor of LAAT and DSEC.
Conclusions: These findings suggest that mean corpuscular volume and red cell distribution width may be linked to left
atrial stasis markers. (AJCD1303004).
Keywords: Atrial fibrillation, stroke, left atrial appendage thrombus, mean corpuscular volume, red cell distribution width,
spontaneous echocardiographic contrast
Address correspondence to: Rui Providência, Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra,
Quinta dos Vales, S. Martinho do Bispo, 3041-853 Coimbra, Portugal. Fax: +351239445737; E-mail:
rui_providencia@yahoo.com
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