Red blood cell distribution width and myocardial scar burden in coronary artery disease.

INTRODUCTION: Red blood cell distribution width (RDW) is a novel independent marker of cardiovascular disease including heart failure, coronary artery disease and myocardial ischaemia. The aim of the study was to investigate a possible relationship between RDW and myocardial scar burden, as assessed by a MIBI viability scan. A secondary objective was to assess whether there is an association between RDW and left ventricular ejection fraction (LVEF). METHODS: The study comprised 123 subjects with ischaemic heart disease who underwent a myocardial viability scan between June 2008 and July 2014. Haemoglobin, mean corpuscular volume, RDW, platelet count, mean platelet volume (MPV), estimated glomerular filtration rate, fasting blood glucose, liver and lipid profiles were evaluated for all patients. The extent of myocardial scarring and LVEF were noted. Data were analysed using IBM SPSS Statistics 22.0. Univariate followed by multivariate analyses were performed to assess for independent predictors of myocardial scarring and LVEF, respectively. RESULTS: The mean age of the study population was 63.5 years; most of the subjects were men. The median LVEF was 31% and median percentage of myocardial scarring was 8.7%. Multivariate analyses revealed that RDW, HDL-cholesterol and alanine transaminase were independent predictors of myocardial scarring while RDW, MPV, LDL-cholesterol and gamma-glutamyl transpeptidase were independent predictors of LVEF. CONCLUSIONS: Increased RDW is an independent predictor both of myocardial scar burden and of impaired left ventricular function in subjects with coronary artery disease.

[A case of effective bisphosphonate therapy for bone metastasis from breast cancer with multiorganic metastases].

A 50-year-old woman with a past history of breast cancer was referred to our department of radiology for detailed examination after abnormal shadows on chest x-ray were detected following a routine medical examination. After lung biopsy via thoracotomy, segmental resection of the lung was performed and mediastinal lymph nodes were dissected. A histopathological diagnosis of breast cancer with lung metastasis and mediastinal lymph-node metastases was made. Later, the patient complained of pain in the left lower extremity. A diagnosis of a left tibial metastasis was made according to bone scintigraphy and MRI. Radiation therapy at 50 Gy was then initiated. Chemotherapy and hormone therapy combined with bisphosphonate therapy (Bisphonal, once in 2 weeks), was also begun. During the treatment, the patient had multiple organ metastases including multiple brain metastases, and metastases to submental lymph nodes and the left adrenal gland. However, her bone metastasis was limited to the left tibial bone and no other bone lesions were detected by bone scintigraphy and MRI. She did not experience adverse effects from the bisphosphonate therapy. We consider that the inhibition of extension and further metastases of the tibial bone metastasis noted in this patient reflected the efficacy of bisphosphonate therapy, and that bisphosphonate therapy might become an essential treatment in patients with bone metastasis of breast cancer.