Vol 69, No 3 (2018)
Original paper
Published online: 2018-03-02
Red cell distribution width — a new marker for exacerbation of heart failure in patients with hypothyroidism following radioiodine therapy
Abstract
Introduction: Cardiovascular diseases constitute a major cause of health problems and death in developed countries across the world. The increased value of the index of distribution of red blood cells volume (RDW) may be a prognostic marker in patients diagnosed with chronic heart failure (CHF). Hypothyroid patients present higher RDW values if compared to healthy controls. Taking into consideration that RDW might be both affected by thyroid status and CHF, we decided to determine the effect of concomitant hypothyroidism following radioiodine therapy (RIT) and CHF on hematological parameters.
Materials and methods: Patients with toxic nodular goiter and heart failure with concomitant anemia were included. Patients underwent treatment with radioiodine before the planned heart transplant or pacemaker implantation (combined ICD/CRT-D). After RIT patients were divided into the three subgroups: with overt hypothyroidism (TSH ≥ 10µIU/mL, Group I), subclinically hypothyroid patients (TSH 4.3-9.0 µIU/mL, Group II) and with high-normal level of TSH (2.6-4.2 µIU/mL, Group III).
Results: Significant correlation between TSH and RDW was observed (r=0.46; P < 0.0001) after RIT, whereas no correlation between serum TSH levels and TIBC and Fe was observed. In Group I significant correlation between TSH and RDW (r= 0.48; P = 0.002) after RIT was observed, whereas in two other subgroups there were no significant correlation.
Conclusions: Subclinical hypothyroidism or high-normal levels of TSH did not affect RDW in a significant manner in the studied population. Our results demonstrates that overt hypothyroidism may contribute to deterioration of CHF reflected in changes of RDW value. < p > < /p >
Keywords: RDWhypothyroidismheart failureradioiodine therapy
References
- Lloyd-Jones D, Adams R, Carnethon M, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee, American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. 2009; 119(3): e21–181.
- McMurray JJ, Stewart S. Epidemiology, aetiology, and prognosis of heart failure. Heart. 2000; 83(5): 596–602.
- Stewart S, MacIntyre K, Hole DJ, et al. More 'malignant' than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail. 2001; 3(3): 315–322.
- Ho KK, Anderson KM, Kannel WB, et al. Survival after the onset of congestive heart failure in Framingham Heart Study subjects. Circulation. 1993; 88(1): 107–115.
- 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.
- Brophy JM, Dagenais GR, McSherry F, et al. A multivariate model for predicting mortality in patients with heart failure and systolic dysfunction. Am J Med. 2004; 116(5): 300–304.
- Dickstein K, Cohen-Solal A, Filippatos G, et al. ESC Committee for Practice Guidelines (CPG), ESC Committee for Practice Guidelines (CPG). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM). Eur Heart J. 2008; 29(19): 2388–2442.
- Pocock S, Wang D, Pfeffer M, et al. Predictors of mortality and morbidity in patients with chronic heart failure. Eur Heart J. 2005; 27(1): 65–75.
- McMurray JJV, Adamopoulos S, Anker SD, et al. Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology, ESC Committee for Practice Guidelines. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012; 14(8): 803–869.
- Anand I, McMurray JJV, Whitmore J, et al. Anemia and its relationship to clinical outcome in heart failure. Circulation. 2004; 110(2): 149–154.
- Anand IS. Anemia and chronic heart failure implications and treatment options. J Am Coll Cardiol. 2008; 52(7): 501–511.
- Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation. 2003; 107(2): 223–225.
- Felker G, Adams K, Gattis W, et al. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol. 2004; 44(5): 959–966.
- Felker GM, Shaw LK, Stough WG, et al. Anemia in patients with heart failure and preserved systolic function. Am Heart J. 2006; 151(2): 457–462.
- Horwich TB, Fonarow GC, Hamilton MA, et al. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002; 39(11): 1780–1786.
- Jankowska E, Ponikowski P. Molecular Changes in Myocardium in the Course of Anemia or Iron Deficiency. Heart Fail Clin. 2010; 6(3): 295–304.
- Kosiborod M, Smith GL, Radford MJ, et al. The prognostic importance of anemia in patients with heart failure. Am J Med. 2003; 114(2): 112–119.
- Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol. 2003; 41(11): 1933–1939.
- Tang YD. Anemia in Chronic Heart Failure: Prevalence, Etiology, Clinical Correlates, and Treatment Options. Circulation. 2006; 113(20): 2454–2461.
- Tanner H, Moschovitis G, Kuster GM, et al. The prevalence of anemia in chronic heart failure. Int J Cardiol. 2002; 86(1): 115–121.
- von Haehling S, Jankowska EA, Ponikowski P, et al. Anemia in heart failure: an overview of current concepts. Future Cardiol. 2011; 7(1): 119–129.
- Al-Ahmad A, Rand WM, Manjunath G, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001; 38(4): 955–962.
- Silverberg DS, Wexler D, Blum M, et al. The use of subcutaneous erythropoietin and intravenous iron for the treatment of the anemia of severe, resistant congestive heart failure improves cardiac and renal function and functional cardiac class, and markedly reduces hospitalizations. J Am Coll Cardiol. 2000; 35(7): 1737–1744.
- Silverberg DS, Wexler D, Palazzuoli A, et al. The anemia of heart failure. Acta Haematol. 2009; 122(2-3): 109–119.
- Gunebakmaz O, Kaya MG, Duran M, et al. Red blood cell distribution width in 'non-dippers' versus 'dippers'. Cardiology. 2012; 123(3): 154–159.
- Nishizaki Y, Yamagami S, Suzuki H, et al. Red blood cell distribution width as an effective tool for detecting fatal heart failure in super-elderly patients. Intern Med. 2012; 51(17): 2271–2276.
- 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.
- Karabulut A, Uzunlar B. Correlation between red cell distribution width and coronary ectasia in the acute myocardial infarction. Clin Appl Thromb Hemost. 2012; 18: 551–552.
- Hong N, Oh J, Kang SM, et al. Red blood cell distribution width predicts early mortality in patients with acute dyspnea. Clin Chim Acta. 2012; 413(11-12): 992–997.
- Hunziker S, Celi LA, Lee J, et al. Red cell distribution width improves the simplified acute physiology score for risk prediction in unselected critically ill patients. Crit Care. 2012; 16(3): R89.
- Ku NSu, Kim HW, Oh HJ, et al. Red blood cell distribution width is an independent predictor of mortality in patients with gram-negative bacteremia. Shock. 2012; 38(2): 123–127.
- de GoC, de LuD, Rodríguez-González S, et al. Interleukin 6, soluble tumor necrosis factor receptor I and red blood cell distribution width as biological markers of functional dependence in an elderly population: a translational approach. Cytokine. 2012; 58: 193–198.
- Bremner AP, Feddema P, Joske DJ, et al. Significant association between thyroid hormones and erythrocyte indices in euthyroid subjects. Clin Endocrinol (Oxf). 2012; 76(2): 304–311.
- Montagnana M, Lippi G, Targher G, et al. The red blood cell distribution width is associated with serum levels of thyroid stimulating hormone in the general population. Int J Lab Hematol. 2009; 31: 581–582.
- Aktas G, Sit M, Dikbas O, et al. Could red cell distribution width be a marker in Hashimoto's thyroiditis? Exp Clin Endocrinol Diabetes. 2014; 122: 572–574.
- Anand IS. Pathophysiology of anemia in heart failure. Heart Fail Clin. 2010; 6(3): 279–288.
- Macchia A, Mariani J, Comignani PD, et al. Anemia and chronic heart failure: from pathophysiologic mechanisms to clinical trial designs. Expert Rev Cardiovasc Ther. 2009; 7(2): 139–145.
- Nanas JN, Matsouka C, Karageorgopoulos D, et al. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol. 2006; 48(12): 2485–2489.
- Okonko DO, Anker SD. Anemia in chronic heart failure: pathogenetic mechanisms. J Card Fail. 2004; 10(1 Suppl): S5–S9.
- Palazzuoli A, Gallotta M, Iovine F, et al. Anaemia in heart failure: a common interaction with renal insufficiency called the cardio-renal anaemia syndrome. Int J Clin Pract. 2008; 62(2): 281–286.
- Ishani A, Weinhandl E, Zhao Z, et al. Angiotensin-converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2005; 45(3): 391–399.
- Plata R, Cornejo A, Arratia C, et al. Commission on Global Advancement of Nephrology (COMGAN), Research Subcommittee of the International Society of Nephrology. Angiotensin-converting-enzyme inhibition therapy in altitude polycythaemia: a prospective randomised trial. Lancet. 2002; 359(9307): 663–666.
- Christ-Crain M, Meier C, Huber P, et al. Effect of restoration of euthyroidism on peripheral blood cells and erythropoietin in women with subclinical hypothyroidism. Hormones (Athens). 2003; 2(4): 237–242.
- Malgor LA, Valsecia ME, Verges EG, et al. Enhancement of erythroid colony growth by triiodothyronine in cell cultures from bone marrow of normal and anemic rats with chronic renal failure. Acta Physiol Pharmacol Ther Latinoam. 1995; 45(2): 79–86.
- M'Rabet-Bensalah K, Aubert CE, Coslovsky M, et al. Thyroid dysfunction and anaemia in a large population-based study. Clin Endocrinol (Oxf). 2016; 84(4): 627–631.
- Levine B, Kalman J, Mayer L, et al. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med. 1990; 323(4): 236–241.
- Torre-Amione G, Bozkurt B, Deswal A, et al. An overview of tumor necrosis factor alpha and the failing human heart. Curr Opin Cardiol. 1999; 14(3): 206–210.
- Rauchhaus M, Doehner W, Francis DP, et al. Plasma Cytokine Parameters and Mortality in Patients With Chronic Heart Failure. Circulation. 2000; 102(25): 3060–3067.
- Ross D. Radioiodine Therapy for Hyperthyroidism. N Engl J Med. 2011; 364(6): 542–550.
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