Prognostic significance of red cell distribution width and its relation to increased pulmonary pressure and inflammation in acute heart failure
Abstract
Background: Red cell distribution width (RDW) in acute heart failure (AHF) is accepted as a prognostic indicator with unclear pathophysiological ties. The aim of this study was to evaluate the prognostic value of RDW in AHF patients in relation to clinical and echocardiographic data.
Methods: 170 patients with AHF were retrospectively studied. All patients had laboratory testing and an echocardiogram performed within 24 h of admission to the Cardiology Department.
Results: During the mean 193 ± 111 days of follow-up, 33 patients died. More advanced age, high RDW and low peak early diastolic velocity of the lateral mitral annulus (MVe’) were independent predictors of all-cause mortality with hazard ratios of: 1.05 (95% CI 1.02–1.09), p < 0.005, 1.40 (95% CI 1.22–1.60), p < 0.001, and 0.77 (95% CI 0.63–0.93), p < 0.007, respectively. In a stepwise multiple linear regression model, RDW was correlated with hemoglobin concentration (standardized b = –0.233, p < 0.001), mean corpuscular volum (standardized b = –0.230, p < 0.001), mean corpuscular hemoglobin concentration (standardized b = –0.207, p < 0.007), the natural logarithm of C-reactive protein (CRP) (standardized b = 0.184, p < 0.004) and tricuspid regurgitation peak gradient (TRPG) values (standardized b = 0.179, p < 0.006), whereas MVe’ was correlated with atrial fibrillation (standardized b = 0.269, p < 0.001).
Conclusions: The present data demonstrates a novel relation between higher levels of RDW and elevated
TRPG and high sensitivity CRP values in patients with AHF. These findings suggest that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic
inflammation in patients with AHF. Moreover, in AHF patients, more advanced age and decreased MVe’ are also independently associated with total mortality risk.
Keywords: acute heart failurered cell distribution widthanemiaMVe’tricuspid regurgitation peak gradienthigh sensitivity C-reactive protein
References
- Roger VL. Epidemiology of heart failure. Circ Res. 2013; 113(6): 646–659.
- Patel K, Ferrucci L, Ershler W, 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.
- Jo YH, Kim K, Lee JH, et al. Red cell distribution width is a prognostic factor in severe sepsis and septic shock. Am J Emerg Med. 2013; 31(3): 545–548.
- Scharte M, Fink MP. Red blood cell physiology in critical illness. Crit Care Med. 2003; 31(12 Suppl): S651–S657.
- Dai Y, Konishi H, Takagi A, et al. Red cell distribution width predicts short- and long-term outcomes of acute congestive heart failure more effectively than hemoglobin. Exp Ther Med. 2014; 8(2): 600–606.
- 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.
- Itani R, Minami Y, Haruki S, et al. Prognostic impact of disseminated intravascular coagulation score in acute heart failure patients referred to a cardiac intensive care unit: a retrospective cohort study. Heart Vessels. 2017; 32(7): 872–879.
- 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.
- Felker GM, Allen LA, Pocock SJ, et al. 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.
- 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.
- Bazick HS, Chang D, Mahadevappa K, et al. Red cell distribution width and all-cause mortality in critically ill patients. Crit Care Med. 2011; 39(8): 1913–1921.
- Hampole CV, Mehrotra AK, Thenappan T, et al. Usefulness of red cell distribution width as a prognostic marker in pulmonary hypertension. Am J Cardiol. 2009; 104: 868–872.
- Senthong V, Hudec T, Neale S, et al. Relation of red cell distribution width to left ventricular end-diastolic pressure and mortality in patients with and without heart failure. Am J Cardiol. 2017; 119(9): 1421–1427.
- Oh J, Kang SM, Hong N, et al. Relation between red cell distribution width with echocardiographic parameters in patients with acute heart failure. J Card Fail. 2009; 15: 517–522.
- Pascual-Figal DA, Bonaque JC, Redondo B, et al. Red blood cell distribution width predicts long-term outcome regardless of anaemia status in acute heart failure patients. Eur J Heart Fail. 2009; 11(9): 840–846.
- Aslan D, Gümrük F, Gürgey A, et al. Importance of RDW value in differential diagnosis of hypochrome anemias. Am J Hematol. 2002; 69(1): 31–33.
- Okonko DO, Mandal AKJ, Missouris CG, et al. Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival. J Am Coll Cardiol. 2011; 58(12): 1241–1251.
- Tkaczyszyn M, Comín-Colet J, Voors AA, et al. Iron deficiency and red cell indices in patients with heart failure. Eur J Heart Fail. 2018; 20(1): 114–122.
- Makhoul BF, Khourieh A, Kaplan M, et al. Relation between changes in red cell distribution width and clinical outcomes in acute decompensated heart failure. Int J Cardiol. 2013; 167: 1412–1416.
- Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005; 352(10): 1011–1023.
- Opasich C, Cazzola M, Scelsi L, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J. 2005; 26(21): 2232–2237.
- Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood. 2003; 102(3): 783–788.
- Lippi G, Targher G, Montagnana M, et al. Relation between red blood cell distribution width and inflammatory biomarkers in a large cohort of unselected outpatients. Arch Pathol Lab Med. 2009; 133: 628–632.
- Condon MR, Kim JE, Deitch EA, et al. Appearance of an erythrocyte population with decreased deformability and hemoglobin content following sepsis. Am J Physiol Heart Circ Physiol. 2003; 284(6): H2177–H2184.
- Papageorgiou N, Tousoulis D, Androulakis E, et al. Inflammation and right ventricle: the hunting of the missing link. Int J Cardiol. 2013; 168(4): 3152–3154.
- Pearson TA, Mensah GA, Alexander RW, et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation. 2003; 107(3): 499–511.
- Lopes AA, Caramurú LH, Maeda NY. Endothelial dysfunction associated with chronic intravascular coagulation in secondary pulmonary hypertension. Clin Appl Thromb Hemost. 2002; 8(4): 353–358.
- Tandon HD, Kasturi J. Pulmonary vascular changes associated with isolated mitral stenosis in India. Br Heart J. 1975; 37(1): 26–36.
- Guazzi M, Naeije R. Pulmonary Hypertension in Heart Failure: Pathophysiology, Pathobiology, and Emerging Clinical Perspectives. J Am Coll Cardiol. 2017; 69(13): 1718–1734.
- Chen D, Assad-Kottner C, Orrego C, et al. Cytokines and acute heart failure. Crit Care Med. 2008; 36(1 Suppl): S9–16.
- Costello ML, Mathieu-Costello O, West JB. Stress failure of alveolar epithelial cells studied by scanning electron microscopy. Am Rev Respir Dis. 1992; 145(6): 1446–1455.
- Hu W, Jin R, Zhang J, et al. The critical roles of platelet activation and reduced NO bioavailability in fatal pulmonary arterial hypertension in a murine hemolysis model. Blood. 2010; 116(9): 1613–1622.
- Targonski R, Sadowski J, Cyganski PA. Impact of anticoagulation on the effectiveness of loop diuretics in heart failure with cardiorenal syndrome and venous thromboembolism. Blood Coagul Fibrinolysis. 2014; 25(2): 180–182.
- Gandhi SK, Powers JC, Nomeir AM, et al. The pathogenesis of acute pulmonary edema associated with hypertension. N Engl J Med. 2001; 344(1): 17–22.
- Flachskampf FA, Biering-Sørensen T, Solomon SD, et al. Cardiac Imaging to Evaluate Left Ventricular Diastolic Function. JACC Cardiovasc Imaging. 2015; 8(9): 1071–1093.
- Wang M, Yip G, Yu CM, et al. Independent and incremental prognostic value of early mitral annulus velocity in patients with impaired left ventricular systolic function. J Am Coll Cardiol. 2005; 45(2): 272–277.
- Zile MR, Gottdiener JS, Hetzel SJ, et al. Prevalence and significance of alterations in cardiac structure and function in patients with heart failure and a preserved ejection fraction. Circulation. 2011; 124(23): 2491–2501.
