Indian Journal of Medical Research

CORRESPONDENCE
Year
: 2015  |  Volume : 141  |  Issue : 3  |  Page : 358--359

Association between red blood cell parameters & atrial fibrillation after acute myocardial infarction


Kazuhiko Kotani1, Masanari Kuwabara2, Toshiyuki Yamada1,  
1 Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi, Japan
2 Department of Cardiology, Toranomon Hospital, Tokyo, Japan

Correspondence Address:
Kazuhiko Kotani
Department of Clinical Laboratory Medicine, Jichi Medical University, Tochigi
Japan




How to cite this article:
Kotani K, Kuwabara M, Yamada T. Association between red blood cell parameters & atrial fibrillation after acute myocardial infarction.Indian J Med Res 2015;141:358-359


How to cite this URL:
Kotani K, Kuwabara M, Yamada T. Association between red blood cell parameters & atrial fibrillation after acute myocardial infarction. Indian J Med Res [serial online] 2015 [cited 2020 Jul 13 ];141:358-359
Available from: http://www.ijmr.org.in/text.asp?2015/141/3/358/156573


Full Text

Sir,

We read with interest the study by Distelmaier and colleagues [1] . They analyzed the association between the blood parameters and new-onset atrial fibrillation (AF) after acute myocardial infarction (MI), as diagnosed with coronary angiography. The patient group with the occurrence of AF after AMI had a significantly higher level of haemoglobin and higher red blood cell counts compared with the group without. The odds ratios of haemoglobin and the red blood cell count for the occurrence of AF were significantly high. The occurrence of AF is multifactorial, and the parameters predictive of AF remain to be explored; therefore, identifying such parameters would be helpful to prevent the development of subsequent adverse complications and mortality in the management of MI patients. The findings of this study are thus valuable, although the authors did not fully seem to state a hypothesis and perspectives for the reported epiphenomenon.

In another recent study conducted by Oda et al[2] , a higher level of haemoglobin was reported to be associated with AF. Both studies [1],[2] appear to have found similar results, which indicate that it is necessary to think about the meaning of red blood cell parameters.

In our clinical experience, a good parameter for the occurrence of AF is ageing, which is referred to as an oxidative condition [3] . We have paid special attention to the relevance of oxidative stress in cardiometabolic pathologies. Notably, oxidative stress conditions are involved in the pathogenesis of AF [3],[4] . Thus, we wonder if some patients had a relatively high red blood cell level (even though it was not at the level of polycytemia), which could have led to oxidative stress. For instance, information obtained from patients with pathologies related to hypoxia, including sleep apnoea syndrome, and measurement of oxidative stress markers should be included in future studies. Additional information about abdominal obesity and the smoking status (which are also associated with oxidative stress) should also be included. Distelmaier group study did not offer such data [1] .

In the Oda group study [2] , erythropoiesis, a factor associated with increased red blood cell parameters, was discussed in terms of the occurrence of AF. This seems to be an important point, considering that hypoxia can also stimulate erythropoiesis. Measuring the erythropoietin level may be of interest in future work. Linked to erythropoiesis, iron metabolism is another point to debate regarding the association between the red cell biology and heart pathophysiology. Ferritin has already been reported to be associated with an increased cardiovascular risk [5] . Measurement of the iron metabolism, therefore, needs to be simultaneously considered.

Hyperhaemodynamic states (accompanied with hyperviscosity) [2] and impaired rheological properties [6] caused by increased red blood cell parameters would be additional points, because these can enhance oxidative stress. Also, a relative decrease in the plasma volume (even if it is not at the level of obvious dehydration) leads to increased red blood cell parameters. Although this cannot be thought to contribute directly to the occurrence of AF, it may provide a potential basis for AF if overlapping some conditions (e.g. sympathetic nerve activation and oxidative stress) are also present [7] .

The fact that the haematocrit level did not show a similar impact on the occurrence of AF in a manner proportional to the haemoglobin and red blood cell counts in this study [1] is seemingly confusing. This implies that subsequent investigation is necessary, while it may also lead to a hint of hypothesis about the association between red blood cell parameters and AF. For more sophisticated future research based on this study [1] , a detailed analysis of the heart rates and blood pressure levels at admission and prior to the onset of AF, as well as unification of the timing of data collection (blood and electrocardiogram examinations), clarification of the underlying diseases (i.e. valvular heart diseases) [8] , and therapeutic situations (including fluid therapy) should be included. Although we outlined an aspect of cardiometabolic pathologies from the viewpoint of oxidative stress, further studies with hypotheses from a wide range of research fields are called for, because these will be useful to identify predictors of the onset of AF during the post-MI management.

References

1Distelmaier K, Maurer G, Goliasch G. Blood count in new onset atrial fibrillation after acute myocardial infarction - A hypothesis generating study. Indian J Med Res 2014; 139 : 579-84.
2Oda E, Oda M, Aizawa Y. Atrial fibrillation (AF) and complete right bundle branch block (RBBB) are independently associated with increased hemoglobin levels in apparently healthy subjects. Intern Med 2013; 52 : 37-43.
3Schillinger KJ, Patel VV. Atrial fibrillation in the elderly: the potential contribution of reactive oxygen species. J Geriatr Cardiol 2012; 9 : 379-88.
4Tousoulis D, Zisimos K, Antoniades C, Stefanadi E, Siasos G, Tsioufis C, et al. Oxidative stress and inflammatory process in patients with atrial fibrillation: the role of left atrium distension. Int J Cardiol 2009; 136 : 258-62.
5You SA, Wang Q. Ferritin in atherosclerosis. Clin Chim Acta 2005; 357 : 1-16.
6El-Sayed MS, Ali N, El-Sayed Ali Z. Haemorheology in exercise and training. Sports Med 2005; 35 : 649-70.
7Chen PS, Chen LS, Fishbein MC, Lin SF, Nattel S. Role of the autonomic nervous system in atrial fibrillation: pathophysiology and therapy. Circ Res 2014; 114 : 1500-15.
8Peverill RE, Harper RW, Smolich JJ. Inverse relation of haematocrit to cardiac index in mitral stenosis and atrial fibrillation. Int J Cardiol 1999; 71 : 149-55.