Cardiovascular Journal of Africa: Vol 28 No 3 (May/June 2017)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 3, May/June 2017 184 AFRICA
PDW is a more specific indicator of platelet activation
than mean platelet volume in the absence of platelet swelling.25
Elevated PDW directly measures the variability in platelet size
during platelet distension and serves as a marker of platelet
activation.26 Increased platelet number and size, and the presence
of pseudopodia may influence PDW. Significant elevation of
PDW has been observed among patients with acute myocardial
infarction and unstable angina pectoris.27
Jindal et al.28 reported a significant association between
PDW and microvascular dysfunction among diabetic patients.
Numerous factors contribute to microvascular and circulatory
dysfunction, including coronary microvascular imbalance and
increased tonus, endothelial thickening of small vessels and
endothelial nitric oxide imbalance, and blood viscosity.
In our study, we detected higher PDW levels in patients
with MB. We assumed that a higher PDW level was related to
increased vasoactive agents, including endothelial nitric oxide
synthase, endothelin-1 and angiotensin-converting enzyme in the
proximal segment of the MB.
The NLR is related to the development of atherosclerosis
in the coronary arteries,29 and NLR is an excellent indicator of
cardiovascular disease.9 Among patients with acute coronary
syndrome, neutrophils are functionally activated, and the
presence of localised neutrophil infiltration in atherosclerotic
lesions has been demonstrated, assuming that neutrophils play
a key role in the mediation and destabilisation of atherosclerotic
plaques.30 Our study demonstrated a significant correlation
between the presence of MB and NLR, an inflammatory marker
linked to early atherosclerosis.
Chronic inflammation may act synergistically to raise RDW
and augment the atherosclerotic process.31 The RDW is an
independent predictor of mortality and coronary morbidity
among patients with myocardial infarction.8 In our study, higher
RDW was found in patients with MB than in the control group.
The relationship between cardiovascular disease and
increased platelet activity is well known. In this study, we found
a significant relationship between MB and PDW, an established
indicator of platelet activity. Additionally, we found a significant
relationship between MB and NLR, an indicator of systemic
inflammation. These predictive parameters are easily measured
and are inexpensive in routine clinical practice.
There were some limitations to this study. We evaluated the
coronary arteries using coronary angiography. Although it is well
known that intravascular ultrasound (IVUS) provides a more
accurate evaluation of coronary atherosclerosis, we were unable
to perform IVUS assessments.
Coronary atherosclerosis is present anatomically in
approximately 25% of patients, based on autopsy and computed
tomography (CT), but results in angiographically detectable
systolic compression in less than 10% of patients. Cardiac CT
angiography may be a useful tool to more precisely detect MB,
however, we were unable to perform cardiac CT angiography in
this study. In addition, the study data are reflective of the cross-
sectional design and may not reflect the long-term clinical status
of the patients.
Conclusion
To the best of our knowledge, this study is the first to evaluate
the relationship between MB and indirect inflammatory markers.
Our study reveals a significant association between indirect
inflammatory markers and MB. Further studies are needed to
clarify the relationship between MB and indirect inflamatory
markers.
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