To the editor,
We have read the recently published article entitled ‘‘Usefulness of the mean platelet volume (MPV) for predicting new-onset atrial fibrillation (AF) after isolated coronary artery bypass grafting (CABG)’ by Erdem and coworkers Citation[1]. In that very well-designed and presented study, Erdem and coworkers tried to determine whether preoperative MPV is associated with the development of AF after CABG. They concluded that MPV was significantly higher in patients with postoperative AF than the control group. In addition, they found that MPV was an independent predictor of postoperative AF with multivariate analyses.
Atrial fibrillation is the most common cardiac arrhythmia in clinical practice, expected to affect millions of people worlwide. AF is responsible for considerable morbidity and mortality, making identification of modifiable risk factors a priority. Postoperative AF usually complicates CABG. New-onset AF after CABG appears to increase short- and long-term mortality. Caucasians are at higher risk for AF after isolated CABG than are persons of other races. Race probably is a surrogate for unrecognized variables such as genetic disparities among racial/ethnic groups Citation[2]. In the previous large population-based study, higher serum phosphorus level and the related calcium-phosphorus product were found to be related to the increased risk of AF Citation[3]. Proteinuria was also apparently linked to the AF Citation[4]. On the other hand, elevated transaminase concentrations were associated with the increased risk of AF Citation[5]. Elevated preoperative brain natriuretic peptide (BNP) levels and advanced age together are significant predictors for the development of postoperative AF in patients undergoing isolated CABG Citation[6].
Clinical trials support evidence that the application of a multidrug prophylaxis can reduce postoperative AF to a low incidence Citation[7]. Preoperative management, such as use of ß-blockers, avoidance of angiotensin-converting enzyme inhibitors, and shorter cardiopulmonary bypass and aortic clamp times can reduce incidence of new-onset AF Citation[8]. Bisphosphonate use was associated with a significant increase in the risk of serious AF Citation[9]. Another interesting study tried to examine whether or not exposure to non-steroidal anti-inflammatory drugs (NSAIDs) was a risk factor for AF. They found that recent NSAID use may predispose patients to AF Citation[10].
Moreover, it was demonstrated that several hemostatic markers are associated with the incidence of AF independent of other cardiovascular risk factors Citation[11]. Platelet abnormalities in AF may underline the etiology of a prothrombotic state in the condition. Increased MPV is a marker of abnormal platelet function and activation Citation[12]. MPV is one of the most widely used laboratory markers related to the platelet function based on inflammatory conditions Citation[13], Citation[14]. MPV also indicates the function of platelet, which is central to processes that are involved in coronary heart disease pathophysiology and endothelial dysfunction Citation[15], Citation[16]. Platelet paremeters can be affected by coronary risk factors, including age, obesity, smoking, diabetes mellitus, hypertension, and hyperlipidemia metabolic syndrome Citation[14]. Some other recent studies have presented that elevated MPV is linked with peripheral artery disease and stroke, all of which are related to atherosclerosis on the basis of inflammation Citation[17]. It can also be affected by thyroid and rheumatic diseases Citation[18], Citation[19], malignancy and medications such as anticoagulant therapy, statins. In a previous study, the authors had demonstrated that MPV showed significant differences in patients with hepatic diseases Citation[20]. On the other hand, MPV value was higher in chronic obstructive pulmonary disease patients compared with those of the control group Citation[21].
Finally, MPV may be affected by many factors, the routine clinical usage of these parameters may not be reasonable yet. MPV itself alone without other overt inflammatory markers may not give information to clinicians about the chronic endothelial inflammatory condition of the patient at the first look. So, we think that it should be evaluated together with other inflammatory markers.
In conclusion, MPV is an essential risk factor for incident AF after CABG and more importantly MPV explains much of the increased AF risk associated with platelet activity in the current study. However, risk factors for incident AF after CABG are very complex and the pivotal roles of those risk factors deserve further large-scale prospective randomized clinical trials.
Declaration of interest
The author reports no conflict of interest. The author alone is responsible for the content and writing of the paper.
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