PREDICTIVE VALUE OF ERYTHROCYTE ANISOTROPY COEFFICIENT IN PATIENTS HOSPITALIZED FOR ACUTELY DECOMPENSATED CHRONIC HEART FAILURE

Aim. To evaluate the role of erythrocyte anisotropy (RDW) coefficient as a predictor of adverse outcome in acutely decompensated chronic heart failure (ADCHF).

Material and methods. Totally, 422 patients, age 37-82 y. o. (mean 66,8±2,3 y. o.) investigated, who had been hospitalized for ADCHF of ischemic origin with decreased ejection fraction (EFLV). All participants underwent routine tests, including the coefficient of erythrocyte anisotropy variation (RDW-CV, RDW-SD), C-reactive peptide (CRP) and brain natriuretic peptide (BNP). Instrumental methods included echocardiography in Mand B-regimens with EFLV measurement. Follow-up in 24 months was done via phone calls with the patient or relatives, and original questionnaire.

Results. At admittance, mean values of RDW-CV were 16,3±2,9%, at discharge — 16,7±3,3%; RDW-SD — 48,7±7,3 fL and 53,6±8,7 fL, respectively. T-test for the relation of these two parameters with fatal outcome showed that only RDW-SD is significantly (p=0,045) relevant, for the period 24 months post discharge. Main group was separated to two subgroups — А (RDW-SD <46,5 fL (n=173)), and B (RDW-SD ≥46,5 fL (n=249)). In aspect of the adverse outcome, group comparison with T-criteria by Student was 6,9 (p=0,0001). There was direct correlation of average strength between hemoglobin contents (r=0,53, р<0,05), creatinine (r=0,55, р<0,05) and С-reactive protein (CRP) (r=0,35; р>0,05), negative correlation for EFLV (r=-0,54, p<0,05) with RDW-SD.

Conclusion. In ADCHF patients the RDW-SD parameter seems to be more significant than RDW-CV in relevance to prediction, and its values correlate with CRP, hemoglobin, creatinine, as negatively also correlate with EFLV. The RDW-SD value higher than 46,5 fL, regardless the other factors, significantly predicts the increase of patients mortality after ADCHF.

Russ J Cardiol 2017, 12 (152): 26–30 http://dx.doi.org/10.15829/1560-4071-2017-12-26-30

acute decompensation, heart failure, two year follow-up, negative prognosis, RDW-SD

1. Arutjunov AG. Risk selection strategy scales, prognosis and severity of patients with ADCHF syndrome. Russ J Cardiol 2013; 2: 50-5. (In Russ.) Арутюнов А. Г. Стратегия выбора шкал риска, прогноза и тяжести пациентов с синдромом ОДХСН. Российский кардиологический журнал 2013, 2: 50-5.

2. Belenkov UN, Oganov RG. Cardiology. National guideline. Moscow: Geotar-Media 2010; p.1232. (In Russ.) Беленков Ю. Н., Оганов Р. Г. Кардиология. Национальное руководство. М.: Гэотар-Медиа, 2010. с.1232.

3. Mareev VYu, Ageev FT, Arutyunov GP, et al. National guidelines OSSN, the RKO and RNMOT for the diagnosis and treatment of chronic heart failure 4th ed. J. Heart Failure 2013; 7 (81): 379-482. (In Russ.) Мареев В. Ю., Агеев Ф. Т., Арутюнов Г. П., и др. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Утверждены на конгрессе ОССН 7 декабря 2012 года, на правлении ОССН 31 марта 2013 года и конгрессе РКО 25 сентября 2013 года. Журнал сердечная недостаточность 2013, 7 (81): 379-482.

4. Fonarow GC. Risk Stratification for In-hospital Mortality in Acutely Decompensated Heart Failure. Classification and Regression Tree Analysis. JAMA 2005; 293: 572-80.

5. Mann DL, Felker GM. Heart Failure: a companion to Braunwald`s heart diseases. 3-rd ed. Elsevir, 2016; p. 761.

6. Belenkov YuN, Mareev VYu, Ageev FT. Modern image f a patient with chronic heart failure in the European part of Russia. J. Heart Failure 2011; 5: 255-9. (In Russ.) Беленков Ю. Н., Мареев В. Ю., Агеев Ф. Т. Современный образ пациента с хронической сердечной недостаточностью в европейской части РФ. Журнал сердечная недостаточность 2011, 5: 255-9.

7. McDonagh T, Gardner RS, Clark AL, Dargie HJ. Oxford Textbook of Неart Failure. Oxford, 2012. p. 524.

8. Prokopova LV, Sitnikova MYu, Dorofeikov VV, et al. Place of non-routine biomarkers of heart failure with a reduced ejection fraction in assessing one-year survival rate: where the road from the “Open prediction” leads. J. Heart failure 2016; 2: 82-90. (In Russ.) Прокопова Л. В., Ситникова М. Ю., Дорофейков В. В.и др. Место нерутинных биомаркеров СН-нФВ в оценке одногодичной выживаемости: куда ведет дорога от “Доступного прогноза”. Журнал Сердечная недостаточность 2016, 17 (2): 82-90.

9. Prokopova LV, Kashuba SM, Galenko VL, et al. The role of routine clinical and laboratory parameters in predicting the one-year prognosis of course of HF with reduced EF in the era of high-tech methods of care: survey “Open prediction”. J. Heart failure 2015; 3 (90): 137-44. (In Russ.) Прокопова Л. В., Кашуба С. М., Галенко В. Л. и др. Роль простых клинико-лабораторных показателей в одногодичном прогнозировании течения СН-нФВ в эпоху высокотехнологичных методов помощи: исследование “Доступный прогноз”. Журнал Сердечная недостаточность 2015, 16 (3): 137-44.

10. Arutyunov AG, Dragunov DO, Arutyunov GP, et al. Prognostically significant phenotypes of patients with decompensation of blood circulation in the Russian Federation. J. Heart failure 2015; 5: 270-8. (In Russ.) Арутюнов, А. Г. Драгунов Д. О., Арутюнов Г. П., Рылова А. К., Соколова А. В., Рылова Н. П. Прогностически значимые фенотипы больных с декомпенсацией кровообращения в РФ. Журнал сердечная недостаточность 2015, 16 (5): 270-8.

11. Testa E, Melchio L, Rinaldi G, et al. Red Cells Distribution (RDW) predicts long-term prognosis in patients hospitalized with acute heart failure: the RDW in Acute Heart Failure (REAHF) study. Eur. J. of HF 2016; 18. Issue S1: 10.

12. Felker GM, Allen LA, Pocock SJ, et al. Red cell distribution width as a novel prognostic marker in heart failure: Data from the CHARM Program and the Duke Databank. Journal of the American College of Cardiology 2007; 50 (1): 40-7.

13. Poljakov DS, Fomin IV, Valikulova AYu, et al. Epidemiological AGE-CHF program: decompensation of chronic heart failure in real clinical practice. J. Heart failure 2016; 17: 299-305. (In Russ.) Поляков Д. С., Фомин И. В., Валикулова Ф. Ю. и др. Эпидемиологическая программа ЭПОХА-ХСН: декомпенсация хронической сердечной недостаточности в реальной клинической практике (ЭПОХА-Д-ХСН). Журнал сердечная недостаточность 2016, 17 (5): 299-305.