Carluccio Erberto, Biagioli Paolo, Alunni Gianfranco, Murrone Adriano, Zingarini Gianluca, Coiro Stefano, D'Antonio Antonella, Mengoni Anna, Cerasa Maria Francesca, Ambrosio Giuseppe
Divisions of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
Divisions of Cardiology, University of Perugia, School of Medicine, Perugia, Italy.
Int J Cardiol. 2017 Sep 15;243:347-353. doi: 10.1016/j.ijcard.2017.05.123. Epub 2017 Jun 2.
Increased red blood cell distribution width (RDW) has been associated with poor outcome after cardiac resynchronization therapy (CRT). However, whether baseline RDW, and its serial changes after CRT implant, have incremental prognostic value is unknown.
In 148 consecutive patients (age, 68±9years; 122 men) undergoing CRT, RDW was assessed before and 3months after implant. Patients were categorized according to baseline RDW (≤14.5% vs >14.5%); and as "stable", "decreased", "increased", relative to post-implant changes. Primary end-point was a composite of death/HF hospitalization during follow-up (median 21months). A reduction in left ventricular (LV) end-systolic volume by ≥15% at 6-month identified LV reverse remodeling. By multivariable logistic regression analysis "increased" (OR:0.22, 95%CI: 0.07-0.69, P=0.010) and "stable-high" RDW at follow-up (OR: 0.39, 95%CI: 0.17-0.89, P=0.027) showed a lower likelihood to develop LV reverse remodeling, while baseline RDW was no longer predictive of LV remodeling. During follow-up, there were 57 events. Baseline RDW>14.5% (HR: 2.24, 95%CI: 1.05-4.77, P=0.036), "increased" (HR: 2.55, 95% CI: 1.09-5.97, P=0.030) and "stable-high" RDW (HR: 2.95, 95% CI: 1.45-5.99, P=0.003) independently predicted outcome after adjusting for functional improvement after CRT, radial dyssynchrony, BNP, creatinine clearance, and left atrial volume index. However, integrated discrimination improvement and net reclassification improvement were not statistically significant when both baseline RDW and its changes were added to a base predictive model.
Increased and stable-high values of RDW were independently associated with both LV reverse remodeling and outcome after CRT; however, RDW did not show any incremental predictive value.
红细胞分布宽度（RDW）增加与心脏再同步治疗（CRT）后的不良预后相关。然而，基线RDW及其在CRT植入后的系列变化是否具有额外的预后价值尚不清楚。
在148例连续接受CRT的患者（年龄68±9岁；男性122例）中，在植入前和植入后3个月评估RDW。根据基线RDW（≤14.5% vs >14.5%）进行分类；并根据植入后的变化分为“稳定”、“降低”、“升高”。主要终点是随访期间（中位时间21个月）死亡/心力衰竭住院的复合终点。6个月时左心室（LV）收缩末期容积减少≥15%确定为LV逆向重构。通过多变量逻辑回归分析，随访时“升高”（OR：0.22，95%CI：0.07-0.69，P=0.010）和“稳定-高”RDW（OR：0.39，95%CI：0.17-0.89，P=0.027）发生LV逆向重构的可能性较低，而基线RDW不再是LV重构的预测指标。随访期间，发生了57起事件。在对CRT后的功能改善、径向不同步、脑钠肽、肌酐清除率和左心房容积指数进行校正后，基线RDW>14.5%（HR：2.24，95%CI：1.05-4.77，P=0.036）、“升高”（HR：2.55，95%CI：1.09-5.97，P=0.030）和“稳定-高”RDW（HR：2.95，95%CI：1.45-5.99，P=0.003）独立预测预后。然而，当将基线RDW及其变化添加到基础预测模型中时，综合判别改善和净重新分类改善无统计学意义。
RDW升高和稳定-高值与CRT后的LV逆向重构和预后均独立相关；然而，RDW未显示任何额外的预测价值。
