TY - JOUR
T1 - Progressive rise in red cell distribution width is associated with poor outcome after transcatheter aortic valve implantation
AU - Aung, Nay
AU - Dworakowski, Rafal
AU - Byrne, Jonathan
AU - Alcock, Emma
AU - Deshpande, Ranjit
AU - Rajagopal, Kailasam
AU - Brickham, Beth
AU - Monaghan, Mark J.
AU - Okonko, Darlington O.
AU - Wendler, Olaf
AU - MacCarthy, Philip A.
PY - 2013/9/1
Y1 - 2013/9/1
N2 - ObjectiveTo investigate the prognostic value of baseline and temporal changes in red cell distribution width (RDW) in patients undergoing transcatheter aortic valve implantation (TAVI).DesignSingle-centre retrospective observational study.SettingTertiary cardiac centre.Patients175 patients undergoing TAVI were included in this study.Main outcome measureSurvival.ResultsWe analysed data from 175 TAVI patients (mean (+/- SD) age 83 +/- 7years, 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 12months, the median rate of change in RDW was 0.2% per month, and 51 (29%) patients died. On multivariate survival analyses, baseline RDW15.5% 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.ConclusionsBaseline RDW15.5% 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.
AB - ObjectiveTo investigate the prognostic value of baseline and temporal changes in red cell distribution width (RDW) in patients undergoing transcatheter aortic valve implantation (TAVI).DesignSingle-centre retrospective observational study.SettingTertiary cardiac centre.Patients175 patients undergoing TAVI were included in this study.Main outcome measureSurvival.ResultsWe analysed data from 175 TAVI patients (mean (+/- SD) age 83 +/- 7years, 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 12months, the median rate of change in RDW was 0.2% per month, and 51 (29%) patients died. On multivariate survival analyses, baseline RDW15.5% 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.ConclusionsBaseline RDW15.5% 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.
KW - IRON-DEFICIENCY ANEMIA
KW - ACUTE HEART-FAILURE
KW - PROGNOSTIC MARKER
KW - RENAL-FUNCTION
KW - MORTALITY
KW - STENOSIS
KW - INFLAMMATION
KW - PREDICTORS
KW - REGISTRY
KW - EVENTS
U2 - 10.1136/heartjnl-2013-303910
DO - 10.1136/heartjnl-2013-303910
M3 - Article
SN - 1355-6037
VL - 99
SP - 1261
EP - 1266
JO - Heart
JF - Heart
IS - 17
ER -