Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 230-238 , March 2010

Validation and Potential Mechanisms of Red Cell Distribution Width as a Prognostic Marker in Heart Failure

  • Larry A. Allen, MD, MHS

      Affiliations

    • Division of Cardiology, University of Colorado Denver, Aurora, CO
  • ,
  • G. Michael Felker, MD, MHS

      Affiliations

    • Department of Medicine, Duke University School of Medicine, Duke Clinical Research Institute, Durham, NC
  • ,
  • Mandeep R. Mehra, MBBS

      Affiliations

    • Department of Medicine, University of Maryland School of Medicine, Baltimore, MD
  • ,
  • Jun R. Chiong, MD, MPH

      Affiliations

    • Department of Medicine, Loma Linda University School of Medicine, Loma Linda, CA
  • ,
  • Stephanie H. Dunlap, DO

      Affiliations

    • Department of Internal Medicine, University of Cincinnati, Cincinnati, OH
  • ,
  • Jalal K. Ghali, MD

      Affiliations

    • Detroit Medical Center, Detroit, MI
  • ,
  • Daniel J. Lenihan, MD

      Affiliations

    • Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX
  • ,
  • Ron M. Oren, MD

      Affiliations

    • Mercy Iowa City, Iowa City, IA
  • ,
  • Lynne E. Wagoner, MD

      Affiliations

    • Greater Cincinnati Cardiovascular Consultants, Cincinnati, OH
  • ,
  • Todd A. Schwartz, DRPH

      Affiliations

    • Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
  • ,
  • Kirkwood F. Adams Jr., MD

      Affiliations

    • Department of Medicine and Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
    • Corresponding Author InformationReprint requests: Kirkwood F. Adams, Jr., MD, Associate Professor of Medicine and Radiology, UNC Heart Failure Program, 730 Martin Luther King Jr. Blvd, Suite 206, Chapel Hill, NC 27514. Tel: 919-966-2877; Fax: 919-966-2888.

Received 26 March 2009 ,Revised 3 November 2009 ,Accepted 6 November 2009.

References 

  1. Al-Ahmad A, Rand WM, Manjunath G, Konstam MA, Salem DN, Levey AS, et al. Reduced kidney function and anemia as risk factors for mortality in patients with left ventricular dysfunction. J Am Coll Cardiol. 2001;38:955–962
  2. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol. 2002;39:1780–1786
  3. Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol. 2003;41:1933–1939
  4. Ezekowitz JA, McAlister FA, Armstrong PW. Anemia is common in heart failure and is associated with poor outcomes: insights from a cohort of 12 065 patients with new-onset heart failure. Circulation. 2003;107:223–225
  5. Felker GM, Gattis WA, Leimberger JD, Adams KF, Cuffe MS, Gheorghiade M, et al. Usefulness of anemia as a predictor of death and rehospitalization in patients with decompensated heart failure. Am J Cardiol. 2003;92:625–628
  6. Tang YD, Katz SD. Anemia in chronic heart failure: prevalence, etiology, clinical correlates, and treatment options. Circulation. 2006;113:2454–2461
  7. Ghali JK. Anemia and heart failure. Curr Opin Cardiol. 2009;24:172–178
  8. van Veldhuisen DJ, McMurray JJ. Are erythropoietin stimulating proteins safe and efficacious in heart failure? Why we need an adequately powered randomised outcome trial. Eur J Heart Fail. 2007;9:110–112
  9. Felker GM, Adams KF, Gattis WA, O'Connor CM. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol. 2004;44:959–966
  10. Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007;50:40–47
  11. Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117:163–168
  12. Cavusoglu E, Chopra V, Gupta A, Battala VR, Poludasu S, Eng C, et al. Relation between red blood cell distribution width (RDW) and all-cause mortality at two years in an unselected population referred for coronary angiography. Int J Cardiol. 2009;article in press
  13. Patel KV, Ferrucci L, Ershler WB, Longo DL, Guralnik JM. Red blood cell distribution width and the risk of death in middle-aged and older adults. Arch Intern Med. 2009;169:515–523
  14. Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med. 2009;169:588–594
  15. Adams KF, Patterson JH, Oren RM, Mehra MR, O'Connor CM, Pina IL, et al. Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry. Am Heart J. 2009;157:926–932
  16. Adams KF, O'Connor CM, Oren RM, Ventura HO, Pina I, Gattis WA, et al. Development of a multicenter heart failure database: initial report from the United Investigators to Evaluate Heart Failure [abstract]. J Card Fail. 2000;6:S2–56
  17. World Health Organization . Iron deficiency anemia, assessment, prevention, and control: report of a WHO Scientific Group. Geneva, Switzerland: WHO; 2001;
  18. Minetti M, Agati L, Malorni W. The microenvironment can shift erythrocytes from a friendly to a harmful behavior: pathogenetic implications for vascular diseases. Cardiovasc Res. 2007;75:21–28
  19. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. 2005;352:1011–1023
  20. Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J. 2005;26:2232–2237
  21. Nanas JN, Matsouka C, Karageorgopoulos D, Leonti A, Tsolakis E, Drakos SG, et al. Etiology of anemia in patients with advanced heart failure. J Am Coll Cardiol. 2006;48:2485–2489
  22. Westenbrink BD, Voors AA, van Veldhuisen DJ. Is anemia in chronic heart failure caused by iron deficiency?. J Am Coll Cardiol. 2007;49:2301–2302
  23. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood. 2003;102:783–788
  24. De Domenico I, Ward DM, Kaplan J. Hepcidin regulation: ironing out the details. J Clin Invest. 2007;117:1755–1758
  25. Nicolas G, Chauvet C, Viatte L, Danan JL, Bigard X, Devaux I, et al. The gene encoding the iron regulatory peptide hepcidin is regulated by anemia, hypoxia, and inflammation. J Clin Invest. 2002;110:1037–1044
  26. Lee P, Peng H, Gelbart T, Wang L, Beutler E. Regulation of hepcidin transcription by interleukin-1 and interleukin-6. Proc Natl Acad Sci USA. 2005;102:1906–1910
  27. Chiari MM, Bagnoli R, De Luca PD, Monti M, Rampoldi E, Cunietti E. Influence of acute inflammation on iron and nutritional status indexes in older inpatients. J Am Geriatr Soc. 1995;43:767–771
  28. Pierce CN, Larson DF. Inflammatory cytokine inhibition of erythropoiesis in patients implanted with a mechanical circulatory assist device. Perfusion. 2005;20:83–90

 Supported by the STAMINA-HFP and UNITE-HF Biomarker registries were funded by Amgen, Inc (Thousand Oaks, CA).

PII: S1071-9164(09)01176-2

doi: 10.1016/j.cardfail.2009.11.003

Journal of Cardiac Failure
Volume 16, Issue 3 , Pages 230-238 , March 2010