Red Cell Distribution Width Predicts 90 Day Mortality in Continuous-Flow Left Ventricular Assist Device Patients

Area of Science:

• Cardiology
• Hematology
• Medical Devices

Background:

• Red cell distribution width (RDW) is a known predictor of cardiovascular disease and heart failure mortality.
• The predictive value of RDW in patients undergoing continuous-flow left ventricular assist device (CF-LVAD) implantation is not well understood.

Purpose of the Study:

• To investigate the association between pre-operative RDW and 90-day mortality in patients receiving a CF-LVAD.
• To evaluate RDW's discriminatory power for mortality risk assessment in CF-LVAD candidates.

Main Methods:

• Retrospective analysis of 409 patients who underwent CF-LVAD implantation between April 2004 and December 2015.
• Assessment of baseline RDW and its correlation with demographic, clinical, and laboratory parameters.
• Statistical analysis to determine RDW's independent predictive value for 90-day mortality.

Main Results:

• Patients with elevated baseline RDW (>15.8%) exhibited significantly lower hemoglobin, lower mean corpuscular volume, higher blood urea nitrogen, lower albumin, and higher total bilirubin.
• RDW was independently predictive of 90-day mortality (OR, 1.16 per 1% increase; CI, 1.04-1.31; p = 0.010).
• RDW's discriminatory power for mortality was comparable to established risk scores like MELD-Xi and HeartMate II.

Conclusions:

• RDW is a valuable and independent predictor of short-term mortality in CF-LVAD recipients.
• RDW, a readily available and inexpensive measure, can enhance risk stratification for patients considered for CF-LVAD implantation.
• Mechanical unloading via CF-LVAD was associated with a reduction in RDW levels post-implantation.