Red cell distribution width and mortality in acute heart failure patients with preserved and reduced ejection fraction.
BACKGROUND
Elevated red blood cell distribution width (RDW) is a valid predictor of outcome in acute heart failure (AHF). It is unknown whether elevated RDW remains predictive in AHF patients with either preserved left ventricular ejection fraction (LVEF) ≥50% or reduced LVEF (<50%).


RESULTS
Prospective local registry including 402 consecutive hospitalized AHF patients without acute coronary syndrome or need of intensive care. The primary outcome was all-cause mortality (ACM) at 1 year after admission. Demographic and clinical data derive from admission, echocardiographic examinations (n= 269; 67%) from hospitalization. The Cox proportional hazard model including all patients (P< 0.001) was adjusted for age, gender, and RDW quartiles. Independent predictors of 1-year ACM were cardiogenic shock (HR 2.86; CI: 1.3-6.4), male sex (HR 1.9; CI: 1.2-2.9), high RDW quartile (HR 1.66; CI: 1.02-2.8), chronic HF (HR 1.61; CI: 1.05-2.5), valvular heart disease (HR 1.61; CI: 1.09-2.4), increased diastolic blood pressure (HR 1.02 per mmHg; CI: 1.01-1.03), increasing age (HR 1.04 by year; CI: 1.02-1.07), platelet count (HR 1.002 per G/l; CI: 1.0-1.004), systolic blood pressure (HR 0.99 per mmHg; CI: 0.98-0.99), and weight (HR 0.98 per kg; CI: 0.97-0.99). A total of 114 patients (28.4%) died within the first year; ACM of all patients increased with quartiles of rising RDW (χ218;P< 0.001). ACM was not different between RDW quartiles of patients with reduced LVEF (n= 153; χ26.6;P= 0.084). In AHF with LVEF ≥50% the probability of ACM increased with rising RDW (n= 116; χ29.9;P= 0.0195).


CONCLUSIONS
High RDW is associated with increased ACM in AHF patients with preserved but not with reduced LVEF in this study population.
Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Konstantinos
K
Sotiropoulos
Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Patrick
P
Yerly
Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Pierre
P
Monney
Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Antoine
A
Garnier
Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Julien
J
Regamey
Service des Urgences Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Olivier
O
Hugli
Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
David
D
Martin
Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Melanie
M
Metrich
Institute of Psychology, Bâtiment Géopolis, Quartier UNIL-Dorigny University of Lausanne Lausanne Switzerland.
Jean-Philippe
JP
Antonietti
Service de Cardiologie, Département de Médecine Interne Centre Hospitalier Universitaire Vaudois, University of Lausanne Lausanne Switzerland.
Roger
R
Hullin
Acute heart failure; Left ventricular ejection fraction; Prognosis; Red cell distribution width