Abstract 4369627: Association Between the Hemoglobin-to-Red Cell Distribution Width Ratio and Mode of Death in Patients With Acute Decompensated Heart Failure: A Stratified Analysis by Ejection Fraction

Abstract

Background: The hemoglobin-to-red blood cell distribution width ratio (HRR), an indicator of inflammation, is acknowledged as a promising new prognostic biomarker and has been reported to be associated with adverse clinical outcome in patients with chronic heart failure. However, there is little information available on the prognostic value of HRR in patients with acute decompensated heart failure (ADHF), in relation to left ventricular ejection fraction (LVEF). Research Questions: We sought to investigate the relationship between HRR and mode of death in ADHF patients with reduced LVEF (HFrEF) and preserved LVEF (HFpEF). Methods: A total of 567 patients with ADHF were prospectively studied, including 309 patients with HFrEF (LVEF less than 50%) and 258 patients with HFpEF (LVEF of 50% or more). All participants underwent venous blood sampling and transthoracic echocardiography at discharge. The endpoint of this study was all-cause death (cardiac death and non-cardiac death). Results: During a mean follow-up period of 3.6±2.9 years, all-cause death was observed in 307 patients (116 patients in cardiac death and 191 patients in non-cardiac death). At multivariate Cox analysis, HRR at discharge was significantly independently associated with all-cause death both in patients with HFrEF (adjusted HR: 0.09 [0.03-0.26], p<0.001) and in those with HFpEF (adjusted HR: 0.29 [0.08-0.99], p=0.047), after multivariate adjustment for potential confounders. Kaplan-Meier analysis revealed that patients with low HRR (defined as 0.821 or less by ROC curve analysis) had a significantly higher risk for all-cause in patients with both HFrEF and HFpEF. As for mode of death, HRR was also significantly independently associated with cardiac death in patients with HFrEF but not in those with HFpEF, although HRR showed the significant association to non-cardiac death in patients with both HFrEF and HFpEF. Cardiac death was significantly more frequently observed in patients with low HRR and HFrEF, but not in those with HFpEF, while patients with low HRR had a significantly higher risk for non-cardiac death in patients with both HFrEF and HFpEF. Conclusion: HRR at discharge was associated with non-cardiac death in ADHF patients, regardless of LVEF, while the prognostic value of HRR for predicting cardiac death was observed in only patients with HFrEF but not HFpEF.