Red cell distribution width improves the prediction of prognosis after transcatheter aortic valve implantation.
OBJECTIVE
The aim of this study was to determine if red cell distribution width (RDW) could improve the prediction of prognosis after transcatheter aortic valve implantation (TAVI).


METHODS
In this single-centre study, 197 consecutive patients underwent TAVI (median age 82 (77-86), 46.2% men). Normal RDW at baseline was defined as ≤15.5%, elevated RDW at baseline was defined as >15.5%. Ouctomes according to the Valve Academic Research Consortium 2 and survival up to one year were compared between these groups.


RESULTS
Compared with the patients with RDW ≤15.5% (n = 168), those with RDW >15.5% (n = 29) had a higher Society of Thoracic Surgeon (STS) score (7.2 vs 5.0%, P = 0.041), higher systolic pulmonary arterial pressure (50 vs 41 mmHg, P = 0.021) and lower haemoglobin (11.5 vs 12.4 mg/dl, P = 0.003). Patients with RDW >15.5% developed significantly more adverse events after TAVI (major vascular complications: 10.3 vs 1.8%, P = 0.042; aortic regurgitation grade II-IV: 50.0 vs 18.0%, P = 0.001) and survival up to 1 year was significantly lower (85.6 vs 65.2%, log-rank: P = 0.007). In addition, RDW >15.5% at baseline was the most significant predictor for mortality (hazard ratio: 2.701 (1.279-5.704), P = 0.009), even when the STS score was added to the model [RDW >15.5%: hazard ratio: 2.276 (1.045-4.954), P = 0.038].


CONCLUSIONS
Elevated RDW is a significant predictor for adverse events and increased 1-year mortality after TAVI. Adding RDW to the classical STS score could be a valuable strategy to improve preoperative risk assessment in potential TAVI candidates.
Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium Department of Cardiology, Antwerp University Hospital, Edegem, Belgium valerie.collas@uza.be valerie.collas@uantwerpen.be.
Valérie M
VM
Collas
Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium.
Bernard P
BP
Paelinck
Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium.
Inez E
IE
Rodrigus
Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Christiaan J
CJ
Vrints
Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Emeline M
EM
Van Craenenbroeck
Faculty of Medicine and Health Sciences, Department of Translational Pathophysiological Research, Cardiovascular Diseases, University of Antwerp, Antwerp, Belgium Department of Cardiology, Antwerp University Hospital, Edegem, Belgium.
Johan M
JM
Bosmans
D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000097:blood / Q000401:mortality / Q000601:surgery*; D004909:Erythrocyte Indices / Q000502:physiology*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D011379:Prognosis; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality*; D016896:Treatment Outcome; D014652:Vascular Diseases / Q000209:etiology / Q000401:mortality
Aortic valve stenosis; Elderly; Red cell distribution width; Transcatheter aortic valve implantation