Relation Between Red Cell Distribution Width with Echocardiographic Parameters in Patients with Acute Heart Failure

Background: Red cell distribution width (RDW) has recently been discovered to be a novel prognostic marker in patients with heart failure. However, the relation between RDW and echocardiographic parameters in acute heart failure (AHF) has not been studied.

Methods And Results: We analyzed laboratory findings including RDW, N-terminal pro-brain natriuretic peptide (NT-proBNP), and echocardiographic parameters in 100 patients with AHF. The mean RDW was 14.2 +/- 2.0% and median NT-proBNP was 5183 pg/mL. The mean left ventricular ejection fraction was 33.1 +/- 14.5% and early mitral inflow velocity to early diastolic mitral annular velocity (E/E'), was 21.2 +/- 9.4. When the RDW was considered in tertile categories, the highest tertile group (> 14.5%) had higher E/E' (P < .001) and higher NT-proBNP (P = .02) than the lowest tertile group (< 13.2%). In multiple linear regression analysis, RDW was independently correlated with E/E' even after adjustment of other risk factors (beta-coefficient 0.431, P = .001). The optimal cutoff value of RDW for predicting E/E' > 15, suggesting elevated left ventricular filling pressure (LVFP) was 13.45% (area under the curve 0.633, P < .05). An additive power of RDW with NT-proBNP for predicting E/E' > 15 was found in logistic regression analysis (P = .038).

Conclusions: We found a novel relation between higher levels of RDW and elevated E/E' in patients with AHF. This novel finding raises the possibility that a simple marker, RDW may be associated with elevated LVFP in patients with AHF.