Prognostic significance of red cell distribution width and its relation to increased pulmonary pressure and inflammation in acute heart failure

Background: Red cell distribution width (RDW) in acute heart failure (AHF) is accepted as a prognostic indicator with unclear pathophysiological ties. The aim of this study was to evaluate the prognostic value of RDW in AHF patients in relation to clinical and echocardiographic data. Methods: 170 patients with AHF were retrospectively studied. All patients had laboratory testing and an echocardiogram performed within 24 h of admission to the Cardiology Department. Results: During the mean 193 +/- 111 days of follow-up, 33 patients died. More advanced age, high RDW and low peak early diastolic velocity of the lateral mitral annulus (MVe') were independent predictors of all-cause mortality with hazard ratios of: 1.05 (95% CI 1.02-1.09), p < 0.005, 1.40 (95% CI 1.22-1.60), p < 0.001, and 0.77 (95% CI 0.63-0.93), p < 0.007, respectively. In a stepwise multiple linear regression model, RDW was correlated with hemoglobin concentration (standardized beta = -0.233, p < 0.001), mean corpuscular volum (standardized beta = -0.230, p < 0.001), mean corpuscular hemoglobin concentration (standardized beta = -0.207, p < 0.007), the natural logarithm of C-reactive protein (CRP) (standardized beta = 0.184, p < 0.004) and tricuspid regurgitation peak gradient (TRPG) values (standardized beta = 0.179, p < 0.006), whereas MVe' was correlated with atrial fibrillation (standardized beta = 0.269, p < 0.001). Conclusions: The present data demonstrates a novel relation between higher levels of RDW and elevated TRPG and high sensitivity CRP values in patients with AHF. These findings suggest that RDW, the most important mortality predictor, is independently associated with elevated pulmonary pressure and systemic inflammation in patients with AHF. Moreover, in AHF patients, more advanced age and decreased MVe' are also independently associated with total mortality risk.