Red Cell Distribution Width to Assess Heart Failure Post Left Ventricular Assist Device Implantation

Abstract

<h3>Purpose</h3> In patients with chronic heart failure (CHF), generalized bone marrow dysfunction affects multiple hematopoietic cell lines. Red cell distribution width (RDW) has been previously identified as prognostic marker in CHF. However, RDW has not been systematically investigated in patients requiring left ventricular assist device (LVAD) therapy. We investigated the impact of RDW on all-cause mortality in this population over a 24-month period post LVAD implantation. <h3>Methods</h3> At a single center, 177 patients received LVAD therapy between June 2011 and October 2018. Patients were divided into three tertiles: RDW <14.4%, 14.1-16.7%, and >16.7%. No patients were excluded. A Kaplan-Meir plot and log-rank statistics were used to compare survival across patient groups. The association between RDW and 24-month all-cause mortality was examined via unadjusted and adjusted cox regression models. <h3>Results</h3> 24-month survival was equal across RDW tertiles (Log-Rank p=0.22). On Cox-modelling, there was no difference in survival seen on either the unadjusted survival [HR= 1.01 (0.94 - 1.09) (p=0.69)] and adjusted survival [1.03 (0.95-1.11) (p=0.47)] when age, race, gender, INTERMACS category, and preoperative RBC mass were adjusted for. <h3>Conclusion</h3> Increased RDW did not correlate with worse survival at 24 months post LVAD placement. As a marker of the variation in circulating red blood cell volume, this lack of association may be due to persistent volume overload in a CHF state.