Association between Red Cell Distribution Width and Mortality after Cardiac Resynchronization Therapy

作者：Topaz Guy; Haim Moti; Kusniec Jairo; Kazum Shirit; Goldenberg Gustavo; Golovchiner Gregory; Kornowski Ran; Stra**erg Boris; Eisen Alon^*

来源：Israel Medical Association Journal, 2015, 17(8): 505-509.

• cardiac resynchronization therapy (CRT)
• red cell distribution width (RDW)
• congestive heart failure (CHF)
• re-hospitalization
• mortality

Background: Cardiac resynchronization therapy (CRT) is a non-pharmacological option for patients with heart failure and interventricular dyssynchrony. Elevated red cell distribution width (ROW) reflects higher size and heterogeneity of erythrocytes and is associated with poor outcome in patients with chronic heart failure.
Objectives: To examine the association between RDW levels and outcomes after CRT implantation.
Methods: We conducted a cohort analysis of 156 patients (126 men, median age 69.0 years) who underwent CRT implantation in our institution during 2004-2008. RDW was measured at three time points before and after implantation. Primary outcome was defined as all-cause mortality, and secondary outcome as hospital re-admissions. We investigated the association between ROW levels and primary outcome during a median follow-up of 61 months.
Results: Ninety-five patients (60.9%) died during follow-up. Higher baseline ROW levels were associated with all-cause mortality (unadjusted HR 1.35, 95%CI 1.20-1.52, P < 0.001). On multivariate analysis adjusted for clinical, electrocardiographic and laboratory variables, baseline ROW levels were associated with mortality (HR 1.33, 95%CI 1.16-1.53). RDW levels 6 months and 12 months post-implantation were also associated with mortality (HR 1.22, 95%CI 1.08-1.38, P = 0.001; and HR 1.15, 95%CI 1.01-1.32, P = 0.02, respectively). Patients who were re-admitted to hospital during follow-up (n=78) had higher baseline ROW levels as compared to those who were not (14.9%, IQR 14.0, 16.0% vs. 14.3%, IQR 13.7, 15.0%, respectively, P = 0.03).
Conclusion: An elevated RDW level before and after CRT implantation is independently associated with all-cause mortality.

• 出版日期2015-8