title: Measurement of the Red Blood Cell Distribution Width Improves the Risk Prediction in Cardiac Resynchronization Therapy.
abstract: OBJECTIVE
  Increases in red blood cell distribution width (RDW) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) predict the mortality of chronic heart failure patients undergoing cardiac resynchronization therapy (CRT). It was hypothesized that RDW is independent of and possibly even superior to NT-proBNP from the aspect of long-term mortality prediction.
  
  
  METHODS
  The blood counts and serum NT-proBNP levels of 134 patients undergoing CRT were measured. Multivariable Cox regression models were applied and reclassification analyses were performed.
  
  
  RESULTS
  After separate adjustment to the basic model of left bundle branch block, beta blocker therapy, and serum creatinine, both the RDW > 13.35% and NT-proBNP > 1975 pg/mL predicted the 5-year mortality (n = 57). In the final model including all variables, the RDW [HR = 2.49 (1.27-4.86); p = 0.008] remained a significant predictor, whereas the NT-proBNP [HR = 1.18 (0.93-3.51); p = 0.07] lost its predictive value. On addition of the RDW measurement, a 64% net reclassification improvement and a 3% integrated discrimination improvement were achieved over the NT-proBNP-adjusted basic model.
  
  
  CONCLUSIONS
  Increased RDW levels accurately predict the long-term mortality of CRT patients independently of NT-proBNP. Reclassification analysis revealed that the RDW improves the risk stratification and could enhance the optimal patient selection for CRT.
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: András Mihály
authors.initials: AM
authors.lastname: Boros
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Péter
authors.initials: P
authors.lastname: Perge
authors.affiliation: Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Zsigmond
authors.initials: Z
authors.lastname: Jenei
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Júlia
authors.initials: J
authors.lastname: Karády
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Endre
authors.initials: E
authors.lastname: Zima
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Levente
authors.initials: L
authors.lastname: Molnár
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Dávid
authors.initials: D
authors.lastname: Becker
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Gellér
authors.affiliation: Third Department of Internal Medicine, Semmelweis University, Budapest, Hungary.
authors.forename: Zoltán
authors.initials: Z
authors.lastname: Prohászka
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
authors.affiliation: Heart and Vascular Center, Semmelweis University, Városmajor Utca 68, Budapest 1122, Hungary.
authors.forename: Gábor
authors.initials: G
authors.lastname: Széplaki
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004909:Erythrocyte Indices; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011237:Predictive Value of Tests; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain