Association between platelet distribution width and prognosis in patients with heart failure

Background The prognostic impact of platelet distribution width (PDW), which is a specific marker of platelet activation, has been unclear in patients with heart failure (HF). Methods and results We conducted a prospective observational study enrolling 1,746 hospitalized patients with HF. Patients were divided into tertiles based on levels of PDW: 1st (PDW < 15.9 fL, n = 586), 2nd (PDW 15.9–16.8 fL, n = 617), and 3rd (PDW ≥ 16.9, n = 543) tertiles. We compared baseline patients’ characteristics and post-discharge prognosis: all-cause death; cardiac death; and cardiac events. The 3rd tertile showed the highest age and levels of B-type natriuretic peptide compared to other tertiles (1st, 2nd, and 3rd tertiles; age, 69.0, 68.0, and 70.0 years old, P = 0.038; B-type natriuretic peptide, 235.2, 171.9, and 241.0 pg/mL, P < 0.001). Left ventricular ejection fraction was equivalent among the tertiles. In the Kaplan-Meier analysis, rates of all endpoints were the highest in the 3rd tertile (log-rank P < 0.001, respectively). The Cox proportional hazard analysis revealed that the 3rd tertile was associated with adverse prognosis (all-cause death, hazard ratio [HR] 1.716, P < 0.001; cardiac death, HR 1.919, P < 0.001; cardiac event, HR 1.401, P = 0.002). Conclusions High PDW is a novel predictor of adverse prognosis in patients with HF.

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Abstract 13332: Platelet Distribution Width is Associated With Adverse Prognosis in Patients With Heart Failure

Circulation ◽

10.1161/circ.142.suppl_3.13332 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Koichiro Watanabe ◽

Yu Sato ◽

Akiomi YOSHIHISA ◽

Yasuhiro Ichijo ◽

Yu Hotsuki ◽

...

Keyword(s):

Diabetes Mellitus ◽

Heart Failure ◽

Chronic Kidney Disease ◽

Kidney Disease ◽

Natriuretic Peptide ◽

Cardiac Death ◽

Left Ventricular Ejection ◽

Platelet Distribution Width ◽

Distribution Width ◽

Patients With Heart Failure

Backgrounds: The associations between red blood cell distribution width and prognosis in patients with heart failure (HF) have been reported. However, the prognostic impact of platelet distribution width (PDW) has been unclear in HF patients. Methods: We conducted a prospective observational study. We analyzed data on 1,746 hospitalized patients with HF who discharged alive and measured PDW at stable condition in prior to discharge. Patients were divided into tertiles based on levels of PDW: 1 st (PDW < 15.9 fL, n = 586), 2 nd (PDW 15.9-16.8 fL, n = 617), and 3 rd (PDW ≥ 16.9, n = 543) tertiles. We compared baseline patients’ characteristics and their post-discharge prognosis such as all-cause death, cardiac death, and cardiac events including cardiac death and re-hospitalization due to worsening HF. Results: Prevalence of diabetes mellitus, anemia, and chronic kidney disease was highest in the 3 rd tertile than in the 1 st and 2 nd tertiles (diabetes mellitus, 42.7% vs. 40.3% and 30.5%, P < 0.001; anemia, 52.5% vs. 48.3% and 41.2%, P < 0.001; chronic kidney disease, 57.5% vs. 49.0% and 49.3%, P = 0.005). Age was oldest and B-type natriuretic peptide levels were highest in the 3 rd tertile compared to the 1 st and 2 nd tertiles (age, 70.0, vs. 69.0 and 68.0 years old, P = 0.038; B-type natriuretic peptide, 241.0 vs. 235.2 and 171.9 pg/mL, P < 0.001). In contrast, sex and left ventricular ejection fraction did not differ among the groups. The Kaplan-Meier analysis ( Figure ) demonstrated that rates of all endpoints were the highest in the 3 rd tertile among the groups (log-rank P < 0.001, respectively). The Cox proportional hazard analysis adjusted for potential confounding factors revealed that the 3 rd tertile was independently associated with adverse prognosis (all-cause death, hazard ratio [HR] 1.312, P = 0.042; cardiac death, HR 1.422, P = 0.046; cardiac event, HR 1.283, P = 0.041). Conclusion: PDW is a novel independent predictor of adverse prognosis in patients with HF.

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Abstract 13104: The Concomitant Inflammation Affect the Ratio of N-terminal Pro B-type Natriuretic Peptide to B-type Natriuretic Peptide in Patients With Heart Failure and Preserved Ejection Fraction

Circulation ◽

10.1161/circ.142.suppl_3.13104 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Tsutomu Kawai ◽

Takahisa Yamada ◽

Tetsuya Watanabe ◽

Shunsuke Tamaki ◽

Shungo Hikoso ◽

...

Keyword(s):

Heart Failure ◽

Ejection Fraction ◽

Natriuretic Peptide ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Preserved Ejection Fraction ◽

Ventricular Ejection Fraction ◽

Inflammatory Status ◽

Patients With Heart Failure ◽

Multicenter Prospective Observational Study

Backgrounds: Although B-type natriuretic peptide (BNP) and N-terminal pro B-type natriuretic peptide (NT-proBNP ) are interrelated parameters in assessment heart failure severity and prognosis, the ratio of NT-proBNP to BNP (NT-proBNP/BNP) are affected by various clinical factors, such as renal function. However, little is known about the influence of inflammation on NT-proBNP/BNP in patients with heart failure and preserved ejection fraction (HFpEF). Methods and Results: Patients data were extracted from PURSUIT-HFpEF registry, which is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Of 871 patients, data of BNP and NT-proBNP was available in 654 patients. The median baseline concentration of BNP was 474 pg/ml (299-720), NT-proBNP was 3310 pg/ml (1740-6840), and NT-proBNP/BNP was 7.6 (5.0-11.8). In multivariable linear regression analyses, older age [odds ratio (OR); 1.05, 95% confidence interval (CI); 1.02-1.09, p=0.001], higher creatinine [OR; 2.63, 95% CI; 1.66-4.16, p<0.001], and higher C-reactive protein (CRP) [OR; 1.17, 95% CI; 1.06-1.28, p<0.001] were significantly associated with a higher NT-proBNP/BNP (>median value of 7.6). However, other factors expected to affect NT-proBNP/BNP, such as atrial fibrillation and body mass index, were not associated with a higher NT-proBNP/BNP in this study. Patients in the highest CRP quartile had significantly higher NT-proBNP/BNP than those with other quartiles. Conclusion: In HFpEF patients, concomitant inflammation was associated with high NT-proBNP/BNP, which indicated that we need a careful interpretation on these two natriuretic peptides of patients with HFpEF and inflammatory status, such as infection.

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