Red blood cell distribution width as a novel prognostic marker after myocardial revascularization or cardiac valve surgery

Abstract

The red blood cell distribution width (RDW) measures the variability in the size of circulating erythrocytes. Previous studies suggested a powerful correlation between RDW obtained from a standard complete blood count and cardiovascular diseases in both primary and secondary cardiovascular prevention. The current study aimed to evaluate the prognostic role of RDW in patients undergoing cardiac rehabilitation after myocardial revascularization and/or cardiac valve surgery. The study included 1.031 patients with available RDW levels, prospectively followed for a mean of 4.5 ± 3.5 years. The mean age was 68 ± 12 years, the mean RDW was 14.7 ± 1.8%; 492 patients (48%) underwent cardiac rehabilitation after myocardial revascularization, 371 (36%) after cardiac valve surgery, 102 (10%) after valve-plus-coronary artery by-pass graft surgery, 66 (6%) for other indications. Kaplan–Meier analysis and Cox hazard analysis were used to associate RDW with mortality. Kaplan–Meier analysis demonstrated worse survival curves free from overall (log-rank p < 0.0001) and cardiovascular (log-rank p < 0.0001) mortality in the highest RDW tertile. Cox analysis showed RDW levels correlated significantly with the probability of overall (HR 1.26; 95% CI 1.19–1.32; p < 0.001) and cardiovascular (HR 1.31; 95% CI 1.23–1.40; p < 0.001) mortality. After multiple adjustments for cardiovascular risk factors, hemoglobin, hematocrit, C-reactive protein, microalbuminuria, atrial fibrillation, glomerular filtration rate,left ventricular ejection fraction and number of exercise training sessions attended, the increased risk of overall (HR 1.10; 95% CI 1.01–1.27; p = 0.039) and cardiovascular (HR 1.13; 95% CI 1.01–1.34; p = 0.036)mortality with increasing RDW values remained significant. The RDW represents an independent predictor of overall and cardiovascular mortality in secondary cardiovascular prevention patients undergoing cardiac rehabilitation.

Omega-3 index is directly associated with a healthy red blood cell distribution width

“…In recent years, RDW has been found to be a predictor of multiple adverse health outcomes unrelated to anemia, including increased risk for death from cardiovascular disease [6][7][8][9][10][11][12], SARS-CoV-2 [13][14][15], sepsis [16,17], lung disease [18], and cancer [19,20]. Like all cell membranes, RBC membranes are a complex lipid bilayer [21].…”

Association of red blood cell distribution width and hemoglobin‐to‐RDW ratio with contrast‐associated acute kidney injury in patients undergoing coronary angiography: A retrospective study

“…32,33 Lazzeroni et al reported the potential of RDW to represent an independent predictor after myocardial revascularization or cardiac valve surgery. 34 Akin et al and Zhao et al found that RDW was associated with the development of CA-AKI in patients with ST-segment elevation myocardial infarction and stable angina pectoris. 35,36 In accordance with previous studies, this study demonstrated that high RDW was an independent risk factor of CA-AKI in all patients after CAG or PCI, indicating that enhanced surveillance of RDW might help to identify CA-AKI earlier.…”

Relationship Between High-Density Lipoprotein-Cholesterol and Red Cell Distribution Width in Patients With Coronary Artery Disease

“…In another study that determined the prognostic value of the RDW, the authors reported an increased mortality rate among patients with above-normal RDWs [22].…”

“…After comparing lipid values across RDW categories adjusted for age, hemoglobin level, and MCV, the RDW was found to be negatively associated with HDL-C levels and positively associated with the atherogenic index of plasma, triglyceride levels, and total cholesterol-to-HDL ratio in women [ 21 ]. In another study that determined the prognostic value of the RDW, the authors reported an increased mortality rate among patients with above-normal RDWs [ 22 ].…”