Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
Int J Clin Pract. 2021 Jun;75(6):e14153. doi: 10.1111/ijcp.14153. Epub 2021 Mar 31.
Red cell distribution width (RDW) is recently emerging as a prognostic indicator in many cardiovascular diseases. However, less is known about its predictive role in patients undergoing transcatheter aortic valve implantation (TAVI).
We retrospectively included very high-risk patients with severe aortic valve stenosis undergoing TAVI between February 2012 and December 2019. Patients were classified according to RDW tertiles. Our primary endpoint was long-term all-cause mortality. The secondary endpoint was a composite of in-hospital major adverse events as defined by the Valve Academic Research Consortium 2 criteria and/or long-term all-cause mortality.
A total of 424 patients [median age 83.5 years, 52.6% females] were analysed. After a median follow-up of 1.55 years, all-cause mortality was 25.5%. At the multivariate-adjusted Cox regression analysis, patients in the highest RDW tertile were associated with a higher risk for all-cause mortality [hazard ratio [HR] 1.73, 95%confidence interval [CI] 1.02-2.95] compared with the lowest tertile. When considering RDW as a continuous variable, we found an 11% increased risk in overall mortality [HR 1.11, 95% CI 1.00-1.24] for each increased point in RDW. The highest RDW tertile was also independently associated with the occurrence of the composite endpoint [odds ratio [OR] 2.10, 95% CI 1.17-3.76] compared with lower tertiles.
In our cohort, elevated basal RDW values were independent predictors of increased long-term mortality and higher rate of in-hospital adverse events. The inclusion of a routinely available biomarker as RDW, may help the pre-operative risk assessment in potential TAVI candidates and optimise their management.
红细胞分布宽度（RDW）最近在许多心血管疾病中成为一种预后指标。然而，关于其在接受经导管主动脉瓣植入术（TAVI）的患者中的预测作用，了解较少。
我们回顾性纳入了 2012 年 2 月至 2019 年 12 月期间接受 TAVI 的极高危重度主动脉瓣狭窄患者。根据 RDW 三分位值将患者进行分类。我们的主要终点是长期全因死亡率。次要终点是 Valve Academic Research Consortium 2 标准定义的住院期间主要不良事件的复合终点和/或长期全因死亡率。
共纳入 424 例患者（中位年龄 83.5 岁，52.6%为女性）。中位随访 1.55 年后，全因死亡率为 25.5%。在多变量调整的 Cox 回归分析中，RDW 最高三分位组患者的全因死亡率风险高于最低三分位组[风险比（HR）1.73，95%置信区间（CI）1.02-2.95]。当将 RDW 视为连续变量时，我们发现 RDW 每增加 1 个点，总体死亡率风险增加 11%[HR 1.11，95%CI 1.00-1.24]。RDW 最高三分位组也与复合终点的发生独立相关[优势比（OR）2.10，95%CI 1.17-3.76]，与较低三分位组相比。
在我们的队列中，基础 RDW 值升高是长期死亡率增加和住院期间不良事件发生率升高的独立预测因素。将 RDW 等常规可用的生物标志物纳入其中，可能有助于潜在 TAVI 候选者的术前风险评估，并优化其管理。
