Review
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Dec 26, 2019; 11(12): 292-304
Published online Dec 26, 2019. doi: 10.4330/wjc.v11.i12.292
Red blood cell distribution width: A marker of anisocytosis potentially associated with atrial fibrillation
Giuseppe Lippi, Gianfranco Cervellin, Fabian Sanchis-Gomar
Giuseppe Lippi, Section of Clinical Biochemistry, University of Verona, Verona 37134, Italy
Gianfranco Cervellin, Emergency Department, University Hospital of Parma, Parma 43126, Italy
Fabian Sanchis-Gomar, Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Valencia 46010, Spain
Author contributions: Lippi G and Cervellin G contributed equally to this work; Lippi G and Sanchis-Gomar F generated the tables and figures; Lippi G, Cervellin G and Sanchis-Gomar F reviewed wrote the paper contributed to editing, reviewing, and final approval of the article.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Fabian Sanchis-Gomar, MD, Research Scientist, Department of Physiology, Faculty of Medicine, University of Valencia and INCLIVA Biomedical Research Institute, Av. Blasco Ibañez 15, Valencia 46010, Spain. fabian.sanchis@uv.es
Telephone: +34-96-5813115 Fax: +34-96-3864642
Received: March 14, 2019
Peer-review started: March 15, 2019
First decision: August 2, 2019
Revised: August 21, 2019
Accepted: October 18, 2019
Article in press: October 18, 2019
Published online: December 26, 2019
Processing time: 280 Days and 21 Hours
Abstract

The incorporation of biomarkers in the actually used risk scores seem to be helpful for early identifying atrial fibrillation (AF) patients at higher risk. The aim of this critical review of the scientific literature is to investigate the potential clinical significance of red blood cell distribution width (RDW) in AF. A systematic electronic search was carried out to identify all articles describing an epidemiological association between RDW and AF in adult human populations. Data abstraction was conducted on a final number of 35 articles (13 cross-sectional, 12 prospective and 10 retrospective studies). The results of these epidemiological investigations were all virtually concordant to emphasize that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis, thromboembolic events and mortality. AF patients with RDW values exceeding the local reference range may be more aggressively investigated and managed, in order to identify and attenuate the impact of possible underlying disorders causing both anisocytosis and AF.

Keywords: Atrial fibrillation; Arrhythmia; Erythrocytes; Red blood cell distribution width

Core tip: This critical review of the scientific literature aims to investigate the potential clinical significance of red blood cell distribution width (RDW) in atrial fibrillation (AF). We concluded that an enhanced RDW value is not only a predictive factor and a marker of AF but its measurement may also be helpful for predicting the risk of developing many adverse complications in patients with AF, such as recurrence and duration of AF, hospitalization for heart failure, bleeding, left atrial thrombosis and stasis, thromboembolic events and mortality.