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, 119 (9), 1421-1427

Relation of Red Cell Distribution Width to Left Ventricular End-Diastolic Pressure and Mortality in Patients With and Without Heart Failure

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Relation of Red Cell Distribution Width to Left Ventricular End-Diastolic Pressure and Mortality in Patients With and Without Heart Failure

Vichai Senthong et al. Am J Cardiol.

Abstract

Higher red cell distribution width (RDW) has been associated with poor prognosis in patients with heart failure (HF). RDW is also closely associated with iron deficiency. However, the mechanism underlying this association is unclear. The relation between left ventricular end-diastolic pressure (LVEDP) and RDW has not been studied, especially in those without HF. We examined the relation between LVEDP and RDW in 1,084 consecutive stable patients who underwent elective coronary angiography. We observed that 38% had high LVEDP (>16 mm Hg) and 29% had history of HF. The median RDW was 13.4%, which was higher with increasing LVEDP (p <0.0001) and significantly higher in patients with HF (p <0.0001). Baseline RDW were independently associated with high LVEDP even after multivariable logistic regression analysis (adjusted odds ratio [OR] per unit change 1.14, 95% confidence interval [CI] 1.0 to 1.29, p = 0.044). Interestingly, result were stronger in non-HF cohort (adjusted OR per unit change 1.37, 95% CI 1.13 to 1.67, p = 0.001). In addition, elevated (third vs first tertiles) RDW levels were independently a predictor of high LVEDP and were associated with a 4.8-fold increased 5-year mortality risk (adjusted hazard ratio 4.11, 95% CI 2.12 to 7.96, p <0.0001), even with the addition of B-type natriuretic peptide to the model (adjusted OR for LVEDP 2.25, 95% CI 1.0 to 5.05, p = 0.05; adjusted hazard ratio for mortality 3.79, 95% CI 1.033 to 13.89, p = 0.044, respectively). In conclusion, high RDW levels were observed in patients with or without HF and independently associated with high LVEDP and with mortality.

Figures

Figure 1
Figure 1
Prevalence of High Left Ventricular End-Diastolic Pressure in the Overall Cohort and in the Non-Heart Failure (HF) Cohort by Red Cell Distribution Width (RDW) Tertiles

Chi-Square, p<0.0001 in the Overall Cohort (n=1,084)

Chi-Square, p=0.018 in the Non-HF Cohort (n=794)

Figure 2
Figure 2
Comparison of Red Cell Distribution Width (RDW) Levels Between Patients With and Without History of Heart Failure (HF) (A) and the Relationship Between RDW Levels and Left Ventricular End-Diastolic Pressure in the Overall Cohort (B)
Figure 2
Figure 2
Comparison of Red Cell Distribution Width (RDW) Levels Between Patients With and Without History of Heart Failure (HF) (A) and the Relationship Between RDW Levels and Left Ventricular End-Diastolic Pressure in the Overall Cohort (B)
Figure 3
Figure 3
Baseline Red Cell Distribution Width (RDW) Levels between Alive and Dead Patients at 5-Year Follow-Up (A) Kaplan-Meier Estimates for 5-Year All-Cause Death with RDW Levels Stratified as Tertiles in the Overall Cohort (B)
Figure 3
Figure 3
Baseline Red Cell Distribution Width (RDW) Levels between Alive and Dead Patients at 5-Year Follow-Up (A) Kaplan-Meier Estimates for 5-Year All-Cause Death with RDW Levels Stratified as Tertiles in the Overall Cohort (B)
Figure 4
Figure 4
Relationship between B-type Natriuretic Peptide (BNP) (A), Mean Corpuscular Hemoglobin Concentration (MCHC) (B) and Red Cell Distribution Width (RDW) Levels in the Overall Cohort
Figure 4
Figure 4
Relationship between B-type Natriuretic Peptide (BNP) (A), Mean Corpuscular Hemoglobin Concentration (MCHC) (B) and Red Cell Distribution Width (RDW) Levels in the Overall Cohort

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