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J Am Coll Cardiol, 2007; 50:40-47, doi:10.1016/j.jacc.2007.02.067 (Published online 17 June 2007).
© 2007 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: HEART FAILURE

Red Cell Distribution Width as a Novel Prognostic Marker in Heart Failure

Data From the CHARM Program and the Duke Databank

G. Michael Felker, MD, MHS, FACC*,*, Larry A. Allen, MD*, Stuart J. Pocock, PhD1,{dagger}, Linda K. Shaw, MS*, John J.V. McMurray, MD, FACC1,{ddagger}, Marc A. Pfeffer, MD, PhD, FACC1,§, Karl Swedberg, MD, PhD, FACC1,||, Duolao Wang, PhD{dagger}, Salim Yusuf, DPhil, FACC1, Eric L. Michelson, MD, FACC2,#, Christopher B. Granger, MD, FACC1,* for the CHARM Investigators

* Duke Clinical Research Institute, Durham, North Carolina
{dagger} London School of Hygiene and Tropical Medicine, London, United Kingdom
{ddagger} University of Glasgow, Glasgow, United Kingdom
§ Brigham and Women’s Hospital, Boston, Massachusetts
|| Department of Medicine, Sahlgrenska University Hospital/Östra, Göteburg, Sweden
McMaster University, Hamilton, Ontario, Canada
# AstraZeneca LP, Wilmington, Delaware.

Manuscript received January 9, 2007; revised manuscript received February 23, 2007, accepted February 25, 2007.

* Reprint requests and correspondence: Dr. G. Michael Felker, Duke Clinical Research Institute, 2400 Pratt Street, Room 0311 Terrace Level, DUMC Box 3850, Durham, North Carolina 27715. (Email: michael.felker{at}duke.edu).

Objectives: The goal of this study was to identify potentially novel laboratory markers of risk in chronic heart failure patients.

Background: Although a variety of prognostic markers have been described in heart failure, a systematic assessment of routine laboratory values has not been reported.

Methods: All 2,679 symptomatic chronic heart failure patients from the North American CHARM (Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity) program had a wide range of laboratory measures performed at a core facility, enabling us to assess the relationship between routine blood tests and outcomes using a Cox proportional hazards model. We then replicated our findings in a cohort of 2,140 heart failure patients from the Duke Databank.

Results: Among 36 laboratory values considered in the CHARM program, higher red cell distribution width (RDW) showed the greatest association with morbidity and mortality (adjusted hazard ratio 1.17 per 1-SD increase, p < 0.001). Higher RDW was among the most powerful overall predictors, with only age and cardiomegaly showing a better independent association with outcome. This finding was replicated in the Duke Databank, in which higher RDW was strongly associated with all-cause mortality (adjusted hazard ratio 1.29 per 1 SD, p < 0.001), second only to age as a predictor of outcome.

Conclusions: In 2 large contemporary heart failure populations, RDW was found to be a very strong independent predictor of morbidity and mortality. Understanding how and why this marker is associated with outcome may provide novel insights into heart failure pathophysiology.

Abbreviations and Acronyms
  ACE = angiotensin-converting enzyme
  HR = hazard ratio
  NYHA = New York Heart Association
  RDW = red cell distribution width




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