title: Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To investigate the prognostic value of baseline and temporal changes in red cell distribution width (RDW) in patients undergoing transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  Single-centre retrospective observational study.
  
  
  METHODS
  Tertiary cardiac centre.
  
  
  METHODS
  175 patients undergoing TAVI were included in this study.
  
  
  METHODS
  Survival.
  
  
  RESULTS
  We analysed data from 175 TAVI patients (mean (± SD) age 83 ± 7 years, 49% men, mean Logistic EuroSCORE 23 ± 1, 66% preserved left ventricular ejection fraction (LVEF)). Immediately pre-TAVI, mean RDW was 14.6 ± 1.6% with an RDW>15% in 29% of patients. Over median follow-up of 12 months, the median rate of change in RDW was 0.2% per month, and 51 (29%) patients died. On multivariate survival analyses, baseline RDW ≥ 15.5% predicted death (adjusted HR 2.70, 95% CI 1.40 to 5.22, p=0.003) independently of LVEF, transfemoral approach, baseline pulmonary artery systolic pressure, moderate/severe mitral regurgitation and body mass index. A greater rate of increase in RDW over time was associated with increased mortality (adjusted HR 1.11, 95% CI 1.04 to 1.18, p=0.001) independently of baseline RDW and other significant temporal variables including a change in creatinine, bilirubin, mean cell haemoglobin concentration or urea. An increase in RDW>0.1%/month was associated with a twofold increased risk of mortality.
  
  
  CONCLUSIONS
  Baseline RDW ≥ 15.5% and a rising RDW over time strongly correlate to an increased risk of death post-TAVI, and could be used to refine risk stratification. Investigating and ameliorating the causes of RDW expansion may improve survival.
authors.affiliation: Cardiovascular Division, King's College Hospital and King's Health Partners, London, UK.
authors.forename: Nay
authors.initials: N
authors.lastname: Aung
authors.forename: Rafal
authors.initials: R
authors.lastname: Dworakowski
authors.forename: Jonathan
authors.initials: J
authors.lastname: Byrne
authors.forename: Emma
authors.initials: E
authors.lastname: Alcock
authors.forename: Ranjit
authors.initials: R
authors.lastname: Deshpande
authors.forename: Kailasam
authors.initials: K
authors.lastname: Rajagopal
authors.forename: Beth
authors.initials: B
authors.lastname: Brickham
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Monaghan
authors.forename: Darlington O
authors.initials: DO
authors.lastname: Okonko
authors.forename: Olaf
authors.initials: O
authors.lastname: Wendler
authors.forename: Philip A
authors.initials: PA
authors.lastname: Maccarthy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D000082882:Bicuspid Aortic Valve Disease; D004909:Erythrocyte Indices / Q000502:physiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000097:blood / Q000401:mortality / Q000601:surgery*; D006349:Heart Valve Diseases / Q000097:blood / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume / Q000502:physiology; D015996:Survival Rate; D016896:Treatment Outcome