Abstract 3559: The Change of Red Cell Distribution Width at 1-month After Discharge Predicts Cardiovascular Events in Acute Heart Failure Patients
Background: Red cell distribution width (RDW) is discovered to be a novel prognostic marker independently N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients (pts) with acute heart failure (AHF). Therefore, we tested the hypothesis that serial measurement of RDW would have a prognostic importance in these pts.
Methods and Results: We analyzed routine laboratory findings including RDW, NT-proBNP and echocardiographic parameters in 250 hospitalized AHF pts (129 males, 65.4±14.1 years old). RDW was measured on admission, at discharge, at 1 month after discharge. We assessed cardiovascular (CV) events during 1-year. The CV events were defined as CV mortality, HF rehospitalization or stroke. On admission, mean RDW, 14.6±2.1 % and median NT-proBNP, 5715.5 (IQR 2450 –13752.75) pg/ml and mean LV ejection fraction (LVEF) was 32.6±14.9 %, respectively. In-hospital mortality was 10.8 % and CV events occurred in 50.4 %. Mean RDW change (Δ) at discharge (n=211) and at 1-month after discharge (n=140) were −0.77±1.58 % and −0.06±1.19 %, respectively compared with RDW on admission. The Kaplan-Meier analysis showed that pts with positive Δ of RDW (n=62) had a significantly higher CV events compared with pts with negative or no Δ of RDW at 1-month after discharge (n=78) (64.1% vs 41.9%, log-rank: p=0.005) but there were no significant differences in CV events on the analysis of RDW change (Δ) at discharge (45.4% vs 44.6%, p=0.87). The positive Δ of RDW at 1-month was an independent predictor of higher CV events after adjusting age, sex, LVEF, log NT-proBNP, estimated glomerular filtration rate and hemoglobin change (hazard ratio: 2.952, 95% CI 1.551–5.619, p=0.001) in Cox proportional hazard analysis.
Conclusion: These findings suggest that measurement of RDW at 1-month after discharge may be a prognostic importance independently of other known risk factors in these pts.