Yamada Shinya, Yoshihisa Akiomi, Kaneshiro Takashi, Amami Kazuaki, Hijioka Naoko, Oikawa Masayoshi, Takeishi Yasuchika
Department of Cardiovascular Medicine Fukushima Medical University Fukushima Japan.
Department of Advanced Cardiac Therapeutics Fukushima Medical University Fukushima Japan.
J Arrhythm. 2020 Oct 8;36(6):1076-1082. doi: 10.1002/joa3.12442. eCollection 2020 Dec.
Both increases in red cell distribution width (RDW) levels and autonomic dysfunction are considered to be correlated with worsening heart failure. However, the relation of RDW levels to autonomic function remains uncertain. We aimed to investigate the association of RDW levels in heart failure with autonomic function, evaluated by heart rate variability (HRV) and heart rate turbulence (HRT), and prognosis.
We studied 222 hospitalized patients with stable heart failure before discharge, and Holter recordings (HRV and HRT) were performed. Additionally, RDW levels were measured, and high RDW was defined as over 14.5%. We then divided the patients into two groups based on RDW levels: high RDW group (>14.5%, n = 92) and low RDW group (≤14.5%, n = 130). The relation of RDW to autonomic function and prognosis was assessed.
In the high RDW group, severely impaired HRV and HRT were found compared to the low RDW group. In the linear regression analysis after the adjustment of multiple confounders, RDW levels were correlated with a low-frequency (LF) to high-frequency (HF) ratio and very low-frequency (VLF) power (LF to HF ratio, β = -0.146, = .027, and VLF power, β = -0.137, = .041, respectively). During the observation period (median 1400 days), cardiac events (re-hospitalization of heart failure, cardiac death or sudden death) were found in 73 (32.8%) patients. The Kaplan-Meier analysis demonstrated that the high RDW group had a higher rate of cardiac events compared to the low RDW group (45.6% vs 23.8%, log-rank < .001).
High RDW levels were correlated with autonomic dysfunction, resulting in poor clinical outcomes.
红细胞分布宽度（RDW）水平升高和自主神经功能障碍均被认为与心力衰竭的恶化相关。然而，RDW水平与自主神经功能之间的关系仍不确定。我们旨在研究心力衰竭患者中RDW水平与通过心率变异性（HRV）和心率震荡（HRT）评估的自主神经功能及预后之间的关联。
我们研究了222例出院前病情稳定的住院心力衰竭患者，并进行了动态心电图记录（HRV和HRT）。此外，测量了RDW水平，高RDW定义为超过14.5%。然后我们根据RDW水平将患者分为两组：高RDW组（>14.5%，n = 92）和低RDW组（≤14.5%，n = 130）。评估了RDW与自主神经功能及预后的关系。
与低RDW组相比，高RDW组中发现HRV和HRT严重受损。在调整多个混杂因素后的线性回归分析中，RDW水平与低频（LF）与高频（HF）比值以及极低频（VLF）功率相关（LF与HF比值，β = -0.146，P = 0.027；VLF功率，β = -0.137，P = 0.041）。在观察期（中位数1400天）内，73例（32.8%）患者发生了心脏事件（心力衰竭再次住院、心源性死亡或猝死）。Kaplan-Meier分析表明，高RDW组的心脏事件发生率高于低RDW组（45.6%对23.8%，对数秩检验P < 0.001）。
高RDW水平与自主神经功能障碍相关，导致临床预后不良。
