Vol 25, No 3 (2018)
Original articles — Clinical cardiology
Published online: 2017-03-27

open access

Page views 4439
Article views/downloads 1319
Get Citation

Connect on Social Media

Connect on Social Media

Prognostic value of red blood cell distribution width in patients with left ventricular systolic dysfunction: Insights from the COMMIT-HF registry

Jarosław Wasilewski, Łukasz Pyka, Michał Hawranek, Mateusz Tajstra, Michał Skrzypek, Michał Wasiak, Kamil Suliga, Kamil Bujak, Mariusz Gąsior
Pubmed: 28353308
Cardiol J 2018;25(3):377-385.

Abstract

Background: Previous studies have reported that in patients with heart failure, an increased value of red cell distribution width (RDW) is associated with adverse outcomes. Nonetheless, data regarding the association between RDW values and long-term mortality in patients with left ventricular systolic dysfunction (LVSD) are lacking. The aim of this investigation was to examine the relationship between mortality and RDW in patients with ischemic and non-ischemic LVSD.

Methods: Under analysis was 1734 patients with a left ventricular ejection fraction (LVEF) ≤ 35% of whom were hospitalized between 2009 and 2013. Patients were divided into three groups based on RDW tertiles. Low, medium and high tertiles were defined as RDW ≤ 13.4%, 13.4% < RDW ≤ 14.6% and RDW > 14.6%, respectively.

Results: There was a stepwise relationship between RDW intervals and comorbidities. Patients with the highest RDW values were older and more often diagnosed with anemia, diabetes, atrial fibrillation and chronic kidney disease. The main finding of our analysis was the presence of an 8-fold increase in all-cause mortality in the entire cohort between high and low RDW tertile. Cox hazard analysis identi­fied RDW as an independent predictive factor of mortality in all patients (HR 2.8; 95% CI 2.1–3.8; p < 0.0001) and in subgroups of patients with ischemic (HR 2.8; 95% CI 2.0–3.9; p < 0.0001) and non-ischemic (HR 3.3; 95% CI 2.01–5.5; p < 0.0001) LVSD.

Conclusions: The highest RDW tertile was independently associated with higher long-term mortality compared with low and medium tertiles, both in all patients with a LVEF ≤ 35% and in subgroups of patients with ischemic and non-ischemic LVSD.

Article available in PDF format

View PDF Download PDF file

References

  1. Ntaios G, Chatzinikolaou A, Saouli Z, et al. Discrimination indices as screening tests for beta-thalassemic trait. Ann Hematol. 2007; 86(7): 487–491.
  2. Osadnik T, Strzelczyk J, Hawranek M, et al. Red cell distribution width is associated with long-term prognosis in patients with stable coronary artery disease. BMC Cardiovasc Disord. 2013; 13: 113.
  3. Bujak K, Wasilewski J, Osadnik T, et al. The prognostic role of red blood cell distribution width in coronary artery disease: A review of the pathophysiology. Dis Markers. 2015; 2015: 824624, doi: 10. 1155/2015/824624, indexed in Pubmed. ; 26379362.
  4. Tonelli M, Sacks F, Arnold M, et al. for the Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2018; 117(2): 163–168.
  5. Sahin O, Akpek M, Sarli B, et al. Association of red blood cell distribution width levels with severity of coronary artery disease in patients with non-ST elevation myocardial infarction. Med Princ Pract. 2015; 24(2): 178–183.
  6. Açıkgöz SK, Açar B, Aydın S, et al. Red Cell Distribution Width Can Predict the Significance of Angiographically Intermediate Coronary Lesions. Med Princ Pract. 2016; 25(1): 31–35.
  7. Çiçek G, Açıkgöz SK, Yayla Ç, et al. White blood cell count to mean platelet volume ratio: A novel and promising prognostic marker for ST-segment elevation myocardial infarction. Cardiol J. 2016; 23(3): 225–235.
  8. Celik T, Balta S, Demir M. Predictive value of admission red cell distribution width-platelet ratio for no-reflow phenomenon in acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Cardiol J. 2016; 23(1): 84–92.
  9. Felker GM, Allen LA, Pocock SJ, et al. CHARM Investigators. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007; 50(1): 40–47.
  10. Allen LA, Felker GM, Mehra MR, et al. Validation and potential mechanisms of red cell distribution width as a prognostic marker in heart failure. J Card Fail. 2010; 16: 230–238.
  11. Huang YL, Hu ZD, Liu SJ. Prognostic value of red blood cell distribution width for patients with heart failure: a systematic review and meta-analysis of cohort studies. PLoS One. 2014; 9: e104861.
  12. van Kimmenade RRJ, Mohammed AA, Uthamalingam S, et al. Red blood cell distribution width and 1-year mortality in acute heart failure. Eur J Heart Fail. 2010; 12(2): 129–136.
  13. Al-Najjar Y, Goode KM, Zhang J, et al. Red cell distribution width: an inexpensive and powerful prognostic marker in heart failure. Eur J Heart Fail. 2009; 11(12): 1155–1162.
  14. Jackson CE, Dalzell JR, Bezlyak V, et al. Red cell distribution width has incremental prognostic value to B-type natriuretic peptide in acute heart failure. Eur J Heart Fail. 2009; 11(12): 1152–1154.
  15. Tajstra M, Pyka Ł, Gorol J, et al. Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry. JACC Cardiovasc Interv. 2016; 9(17): 1790–1797.
  16. Gąsior M, Pyka Ł, Gorol J, et al. COnteMporary Modalities In Treatment of Heart Failure: a report from the COMMIT-HF registry. Kardiol Pol. 2016; 74(6): 523–528.
  17. Skjelbakken T, Lappegård J, Ellingsen TS, et al. Red cell distribution width is associated with incident myocardial infarction in a general population: the Tromsø Study. J Am Heart Assoc. 2014; 3(4).
  18. Veeranna V, Zalawadiya SK, Panaich S, et al. Comparative analysis of red cell distribution width and high sensitivity C-reactive protein for coronary heart disease mortality prediction in multi-ethnic population: Findings from the 1999–2004 NHANES. Int J Cardiol. 2013; 168: 5156–5161.
  19. Sargento L, Simões AV, Longo S, et al. Red blood cell distribution width is a survival predictor beyond anemia and Nt-ProBNP in stable optimally medicated heart failure with reduced ejection fraction outpatients. Clin Hemorheol Microcirc. 2017; 65(2): 185–194.
  20. Bozorgi A, Mehrabi Nasab E, Khoshnevis M, et al. Red Cell Distribution Width and Severe Left Ventricular Dysfunction in Ischemic Heart Failure. Crit Pathw Cardiol. 2016; 15(4): 174–178.
  21. Sotiropoulos K, Yerly P, Monney P, et al. Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction. ESC Heart Fail. 2016; 3(3): 198–204.
  22. Patel KV, Semba RD, Ferrucci L, et al. Red cell distribution width and mortality in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2010; 65(3): 258–265.
  23. Patel KV, Ferrucci L, Ershler WB, et al. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009; 169(5): 515–523.
  24. Pascual-Figal DA, Bonaque JC, Manzano-Fernández S, et al. Red blood cell distribution width predicts new-onset anemia in heart failure patients. Int J Cardiol. 2012; 160(3): 196–200.
  25. Förhécz Z, Gombos T, Borgulya G, et al. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am Heart J. 2009; 158(4): 659–666.
  26. Jankowska EA, Rozentryt P, Witkowska A, et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J. 2010; 31(15): 1872–1880.
  27. Owczarek A, Babińska M, Szyguła-Jurkiewicz B, et al. [Chronic inflammation in patients with acute coronary syndrome and chronic kidney disease]. Kardiol Pol. 2011; 69(4): 388–393.
  28. Vayá A, Sarnago A, Fuster O, et al. Influence of inflammatory and lipidic parameters on red blood cell distribution width in a healthy population. Clin Hemorheol Microcirc. 2015; 59: 379–385.
  29. Emans ME, van de, van Ro, et al. Determinants of red cell distribution width (RDW) in cardiorenal patients: RDW is not related to erythropoietin resistance. J Card Fail. 2011; 17(8): 626–633.
  30. Afsar B, Saglam M, Yuceturk C, et al. The relationship between red cell distribution width with erythropoietin resistance in iron replete hemodialysis patients. Eur J Intern Med. 2013; 24: e25–e29.
  31. Osadnik T, Wasilewski J, Lekston A, et al. Comparison of modification of diet in renal disease and chronic kidney disease epidemiology collaboration formulas in predicting long-term outcomes in patients undergoing stent implantation due to stable coronary artery disease. Clin Res Cardiol. 2014; 103(7): 569–576.
  32. Lippi G, Targher G, Montagnana M, et al. Relationship between red blood cell distribution width and kidney function tests in a large cohort of unselected outpatients. Scand J Clin Lab Invest. 2008; 68: 745–748.
  33. Friedman JS, Lopez MF, Fleming MD, et al. SOD2-deficiency anemia: protein oxidation and altered protein expression reveal targets of damage, stress response, and antioxidant responsiveness. Blood. 2004; 104(8): 2565–2573.
  34. Zhang PY, Xu X, Li XC. Cardiovascular diseases: oxidative damage and antioxidant protection. Eur Rev Med Pharmacol Sci. 2014; 18(20): 3091–3096.