Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Feb 26, 2016; 8(2): 220-230
Published online Feb 26, 2016. doi: 10.4330/wjc.v8.i2.220
Red cell distribution width in anemic patients undergoing transcatheter aortic valve implantation
Katharina Hellhammer, Tobias Zeus, Pablo E Verde, Verena Veulemanns, Lisa Kahlstadt, Georg Wolff, Ralf Erkens, Ralf Westenfeld, Eliano P Navarese, Marc W Merx, Tienush Rassaf, Malte Kelm
Katharina Hellhammer, Tobias Zeus, Verena Veulemanns, Lisa Kahlstadt, Georg Wolff, Ralf Erkens, Ralf Westenfeld, Eliano P Navarese, Marc W Merx, Tienush Rassaf, Malte Kelm, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany
Pablo E Verde, Coordination Center for Clinical Trials, Medical Faculty, University Düsseldorf, 40225 Düsseldorf, Germany
Malte Kelm, Cardiovascular Research Institute Düsseldorf, University Düsseldorf, 40225 Düsseldorf, Germany
Author contributions: Hellhammer K and Zeus T performed the research and wrote the paper; Verde PE designed the research and contributed to the analysis; Veulemanns V and Kahlstadt L designed the research and supervised the report; Wolff G, Erkens R, Westenfeld R, Navarese EP and Merx MW provided clinical advice; Rassaf T and Kelm M supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the University Hospital Düsseldorf.
Informed consent statement: Patients were not required to give informed. To the study because the analysis used anonymous clinical data that was obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors has conflicts of interest to declare. There is no existing relation with the industry.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Tienush Rassaf, MD, Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Düsseldorf, Moorenstr, 5, 40225 Düsseldorf, Germany. tienush.rassaf@med.uni-duesseldorf.de
Telephone: +49-211-8118801 Fax: +49-211-8118812
Received: June 29, 2015
Peer-review started: July 4, 2015
First decision: Septermber 17, 2015
Revised: October 4, 2015
Accepted: November 23, 2015
Article in press: November 25, 2015
Published online: February 26, 2016
Processing time: 237 Days and 11.3 Hours
Abstract

AIM: To determine the impact of red blood cell distribution width on outcome in anemic patients undergoing transcatheter aortic valve implantation (TAVI).

METHODS: In a retrospective single center cohort study we determined the impact of baseline red cell distribution width (RDW) and anemia on outcome in 376 patients with aortic stenosis undergoing TAVI. All patients were discussed in the institutional heart team and declined for surgical aortic valve replacement due to high operative risk. Collected data included patient characteristics, imaging findings, periprocedural in hospital data, laboratory results and follow up data. Blood samples for hematology and biochemistry analysis were taken from every patient before and at fixed intervals up to 72 h after TAVI including blood count and creatinine. Descriptive statistics were used for patient’s characteristics. Kaplan-Meier survival curves were used for time to event outcomes. A recursive partitioning regression and classification was used to investigate the association between potential risk factors and outcome variables.

RESULTS: Mean age in our study population was 81 ± 6.1 years. Anemia was prevalent in 63.6% (n = 239) of our patients. Age and creatinine were identified as risk factors for anemia. In our study population, anemia per se did influence 30-d mortality but did not predict longterm mortality. In contrast, a RDW > 14% showed to be highly predictable for a reduced short- and longterm survival in patients with aortic valve disease after TAVI procedure.

CONCLUSION: Age and kidney function determine the degree of anemia. The anisocytosis of red blood cells in anemic patients supplements prognostic information in addition to that derived from the WHO-based definition of anemia.

Keywords: Anemia; Red cell distribution width; Red blood cells; Transcatheter aortic valve implantation; Aortic stenosis

Core tip: This is a retrospective study to evaluate the impact of prevalent anemia and the importance of red cell distribution width (RDW) on the outcome in patients undergoing transcatheter aortic valve replacement. Anemia was prevalent 63.6% of the patients and did influence 30-d mortality but did not predict longterm mortality. In contrast, a RDW > 14% showed to be highly predictable for a reduced short- and long-term survival in patients with aortic valve disease after transcatheter aortic valve implantation procedure. Age and creatinine were identified as risk factors for anemia.