Abstract
BackgroundRed blood cell distribution width (RDW) is a measurement of variability in circulating erythrocytes size, and has recently been shown to correlate with prognosis in a variety of human diseases, including acute and chronic heart failure. ObjectivesTo determine if RDW differs between healthy controls, cats with hypertrophic cardiomyopathy (HCM) without congestive heart failure (CHF) and cats with HCM and CHF, and to evaluate whether RDW values at presentation can provide useful prognostic information in cats with HCM. AnimalsRetrospective single-centre study. Seventy-three cats diagnosed with HCM by echocardiography and 30 healthy controls presented to a veterinary teaching hospital between October 2006 and April 2013 were included. Physical examination, haematology and echocardiographic data obtained on one single visit were retrospectively reviewed and compared between three groups: controls, cats with HCM without CHF, and cats with HCM and CHF. Outcome data were obtained from clinical records or referring veterinarians. Univariable and multivariable survival analyses were performed. ResultsRed blood cell distribution width was significantly greater in cats with HCM and CHF compared with cats with HCM without CHF, and the controls. It was also significantly associated with cardiac mortality in univariable survival analysis, and this association remained significant in multivariable survival analysis after controlling for the effect of CHF, left atrial size, left ventricular systolic function, haematocrit and pro-thrombotic state. ConclusionsA higher RDW may be seen in cats with CHF and is an independent predictor of cardiac death in cats with HCM without concurrent non-cardiac-related illness.
Highlights
Red Blood Cell Distribution Width (RDW) has been correlated with prognosis in a variety of different human diseases, including acute and chronic heart failure,3-10 with an increase in RDW values associated with a decrease in survival time
Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats, and several negative prognostic factors associated with decreased survival time have been identified, including the presence of: arterial thromboembolism, congestive heart failure, left atrial dilation, left ventricular and left atrial systolic dysfunction, extreme ventricular hypertrophy and elevation in cardiac biomarkers. 13-17
RDW has been investigated in veterinary patients as an index of regenerative anaemia 18, 19 and in dogs with mitral valve disease20 and pulmonary hypertension.b, 21 no association between RDW and outcome has been established in these studies
Summary
Red Blood Cell Distribution Width (RDW) is a measurement of the heterogeneity of red blood cell size distribution data and is routinely reported by automated haematology analysers. RDW is defined as the coefficient of variation of the red blood cell size; it has historically been used for the classification of anaemia.Recently, RDW has been correlated with prognosis in a variety of different human diseases, including acute and chronic heart failure, with an increase in RDW values associated with a decrease in survival time.The proposed mechanisms for the alteration of RDW in these patients include: inflammatory stress, nutritional deficiencies, impaired iron metabolism, inadequate production of erythropoietin, and the impact of comorbidities.8, 11, 12Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats, and several negative prognostic factors associated with decreased survival time have been identified, including the presence of: arterial thromboembolism, congestive heart failure, left atrial dilation, left ventricular and left atrial systolic dysfunction, extreme ventricular hypertrophy and elevation in cardiac biomarkers. 13-17RDW has been investigated in veterinary patients as an index of regenerative anaemia 18, 19 and in dogs with mitral valve disease and pulmonary hypertension.b, 21 no association between RDW and outcome has been established in these studies. RDW is defined as the coefficient of variation of the red blood cell size; it has historically been used for the classification of anaemia. RDW has been correlated with prognosis in a variety of different human diseases, including acute and chronic heart failure, with an increase in RDW values associated with a decrease in survival time. Hypertrophic cardiomyopathy (HCM) is the most common cardiac disease in cats, and several negative prognostic factors associated with decreased survival time have been identified, including the presence of: arterial thromboembolism, congestive heart failure, left atrial dilation, left ventricular and left atrial systolic dysfunction, extreme ventricular hypertrophy and elevation in cardiac biomarkers. RDW has been investigated in veterinary patients as an index of regenerative anaemia 18, 19 and in dogs with mitral valve disease and pulmonary hypertension.b, 21 no association between RDW and outcome has been established in these studies. To date there have been no publications evaluating RDW as a prognostic indicator in feline patients
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