Red blood cell distribution width in heart failure: A narrative review

Abstract

The red blood cell distribution width (RDW) is a simple, rapid, inexpensive and straightforward hematological parameter, reflecting the degree of anisocytosis in vivo. The currently available scientific evidence suggests that RDW assessment not only predicts the risk of adverse outcomes (cardiovascular and all-cause mortality, hospitalization for acute decompensation or worsened left ventricular function) in patients with acute and chronic heart failure (HF), but is also a significant and independent predictor of developing HF in patients free of this condition. Regarding the biological interplay between impaired hematopoiesis and cardiac dysfunction, many of the different conditions associated with increased heterogeneity of erythrocyte volume (i.e., ageing, inflammation, oxidative stress, nutritional deficiencies and impaired renal function), may be concomitantly present in patients with HF, whilst anisocytosis may also directly contribute to the development and worsening of HF. In conclusion, the longitudinal assessment of RDW changes over time may be considered an efficient measure to help predicting the risk of both development and progression of HF.

Red Cell Distribution Width Is a Risk Factor for Hip Fracture in Elderly Men Without Anemia

“…Therefore, higher RDW might reflect disturbed hematopoiesis with aging‐related CH. Chronic inflammation suppresses bone marrow erythropoiesis and consequently affects the heterogeneity of RBC size . Inflammation also affects BMD or risks of fracture, either directly or indirectly .…”

“…Although biologic mechanisms are unclear, the RDW might reflect changes in hematopoiesis with aging . In addition, based on its association with age and a wide range of aging‐related conditions, increased RDW might reflect a fundamental process of cellular aging …”

Predictive value of left ventricular myocardial strain by four‐dimensional speckle tracking echocardiography combined with red cell distribution width in heart failure with preserved ejection fraction

“…The role of RDW in HF is unclear, but its value in HF has been demonstrated to be independent of anemia . With regard to the biological interaction between impaired hematopoiesis and cardiac dysfunction, many of the various situations related to increased heterogeneity of erythrocyte volume (ie, aging, inflammation, oxidative stress, nutritional deficiencies, and renal dysfunction) may exist concomitantly in patients with HF, while anisocytosis may also directly result in the progression and deterioration of HF . Förhécz et al exclude certain factors associated with worsening HF, such as iron deficiency, inflammation, ineffective erythropoiesis, malnutrition, and neurohormonal activation, confirming that RDW was independently associated with adverse outcomes in HF.…”

“…29,30 With regard to the biological interaction between impaired hematopoiesis and cardiac dysfunction, many of the various situations related to increased heterogeneity of erythrocyte volume (ie, aging, inflammation, oxidative stress, nutritional deficiencies, and renal dysfunction) may exist concomitantly in patients with HF, while anisocytosis may also directly result in the progression and deterioration of HF. 31 Förhécz et al 32 Abbreviations: E/e' = the ratio of transmitral early peak velocity (E) to mitral annulus velocity (e'); GAS = global area strain; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; HFpEF = heart failure with preserved ejection fraction; IVST = interventricular septal thickness; LVEDVI = left ventricular end-diastolic volume index; LVMI = left ventricular mass index; NYHA = New York Heart Association (NYHA) class; RDW = red cell distribution width. Abbreviations: E/e' = the ratio of transmitral early peak velocity (E) to mitral annulus velocity (e'); GAS = global area strain; GCS = global circumferential strain; GLS = global longitudinal strain; GRS = global radial strain; HFpEF = heart failure with preserved ejection fraction; IVST = interventricular septal thickness; LVEDVI = left ventricular end-diastolic volume index; LVMI = left ventricular mass index; NYHA = New York Heart Association (NYHA) class; RDW = red cell distribution width.…”

The diagnostic and prognostic value of red cell distribution width in cardiovascular disease; current status and prospective

“…Moreover, abnormal RBCs may participate in development of cardiac fibrosis by amplification of inflammation . Such effects will result in decreased oxygenation of many organs including cardiomyocytes and predispose human cardiovascular system to different pathologies including ischemia and organ failure . The purpose of this review was to summarize the results of recent studies that have investigated the diagnostic and prognostic value of RDW in CVD.…”