New Markers of Platelet Activation and Reactivity and Oxidative Stress Parameters in Patients Undergoing Coronary Artery Bypass Grafting

Abstract

Objective. Recent studies have shown that the red cell distribution width- (RDW-) to-platelet (PLT) count ratio (i.e., RPR) and the mean platelet volume (MPV)/PLT ratio (i.e. MPR) are more sensitive markers of atherosclerosis-connected risk than RDW and PLT alone. The present study is aimed at investigating the oxidative stress status and these two new markers of platelet activation in two different heart surgery modalities: cardiopulmonary bypass (CPB) and off-pump coronary artery bypass (OPCAB). We also aimed to test the possible relationship between RPR and MPR, respectively, and the severity and complexity of atherosclerotic plaque, measured as Syntax Score. Patients and Methods. A total of 107 patients encompassed this prospective study (i.e., 60 patients in CPB group and 47 patients in OPCAB). Blood samples were drawn at several time intervals: before skin incision (t1), immediately after intervention (t2), 6 h (t3), 24 h (t4), 48 h (t5), and 96 h after cessation of the operation (t6). Results. The values of RPR and MPR were similar in CPB and OPCAB before surgery and started to rise in t2 (i.e., immediately after the intervention). This increase lasted to t5 (i.e., 48 hours after the intervention), when it became the highest. After that, both markers started to regress about the 96th hour after the beginning of surgery. Nominal values of both indices were higher in CPB than in OPCAB in all study points after the surgery. Furthermore, a significantly higher level of antioxidative parameters (i.e., total sulfhydryl groups and paraoxonase 1) in the OPCAB group compared to the CPB group was noted at t5 study point (i.e., 48 hours after the surgery), whereas no significant difference was noted in prooxidant levels (i.e., lipid hydroperoxides and advanced oxidation protein products) between these groups at this study point. MPR and RPR correlated positively with Syntax Score at several study points after the surgery completion. Syntax Score, MPR, and RPR showed good clinical accuracy in surgery-related complication prediction (( AUC = 0.736 ), 95th CI (0.616-0.856), P = 0.003 )). Conclusion. When combined, MPV, RDW, and platelet count, such as MPR and RPR, could be good predictors of coronary artery disease status, regarding the aspect of joint inflammation, oxidative stress, and thrombosis.

Predictive Value of Red Blood Cell Distribution Width and Atrial Diameter in Paroxysmal Atrial Fibrillation: A Cross-Sectional Study

“…Evidence had shown that MPV is closely related to cardiovascular risk factors, such as diabetes, hypertension, and hypercholesterolemia [ 25 ]. The studies had shown an inflammatory and thrombotic predictive role of MPV/PLT in many other diseases, such as obesity, type 2 diabetes, and hepatosteatosis [ 26 ]. Our results also showed that MPV/PLT in the paroxysmal AF group was significantly higher than that in the control group, suggesting that this indicator can be used to predict the occurrence of paroxysmal AF.…”

Association between inflammatory markers and non-alcoholic fatty liver disease in obese children

“…In addition, various studies have reported elevated levels of pro-inflammatory cytokines in NAFLD patients ( 20 , 21 ). Similar to inflammatory cytokines, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width (PDW) have recently been used as potential novel biomarkers of inflammatory progress ( 22 , 23 ). A study found that NLR was elevated in advanced inflammation, which was useful in assessing the extent of disease in patients with NAFLD ( 24 ).…”

“…Another study found that platelets played an essential role in the spread and initiation of inflammatory diseases ( 25 ). And MPV and PDW could be considered as markers of platelet activation and function ( 23 ). However, the relationship between these inflammatory markers and NAFLD remains controversial.…”

Evaluation of Antioxidant Therapeutic Value of ACE Inhibitor as Adjunct Therapy on Type 2 Diabetes Mellitus Patients with Cardiovascular Disease

“…6 Oxidative stress, inflammation, and thrombosis are cofactors that participate in the progression of atherosclerosis. 7 Diabetes can upregulate inflammatory markers such as white blood cells, granulocytes, and monocytes, which promote the production of reactive oxygen species (ROS) and eventually result in vascular dysfunction. 8 Oxidative damage can result from increased free radical production, insufficient antioxidant potential, or both.…”

“…Oxidative stress is essential in the pathogenesis of cardiovascular disease, stimulating vascular inflammation and promoting inflammatory responses and cytokines . Oxidative stress, inflammation, and thrombosis are cofactors that participate in the progression of atherosclerosis . Diabetes can upregulate inflammatory markers such as white blood cells, granulocytes, and monocytes, which promote the production of reactive oxygen species (ROS) and eventually result in vascular dysfunction…”