Key result
Higher red cell distribution width-albumin ratio is linked to ~2.3-fold higher odds of impaired LVGLS.
Why the study?
The association between the red cell distribution width–albumin ratio and subclinical myocardial impairment, heart failure hospitalization, and mortality was not well characterized.
Does a higher red cell distribution width-albumin ratio predict impaired LVGLS, heart failure hospitalization, and all-cause mortality in adults undergoing echocardiography?
Cohort (n=5,069)
Yes
Does a higher red cell distribution width-albumin ratio predict impaired LVGLS, heart failure hospitalization, and all-cause mortality in adults undergoing echocardiography?
While a higher red cell distribution width-albumin ratio is independently associated with subclinical myocardial impairment, heart failure hospitalization, and mortality, it does not offer discriminative value beyond its individual components.
Answers are grounded in this paper and cite their sources.
Supports RAR as potential prognostic marker in echocardiography cohorts; leaves open incremental value beyond RDW/albumin and need for validation.
Aims: The aims of this study were to evaluate the association between the red cell distribution width (RDW)–albumin ratio (RAR) and subclinical myocardial impairment, as assessed by left ventricular global longitudinal strain (LVGLS), and to examine the relationships between the RAR, heart failure (HF) hospitalization, and all-cause mortality. Methods: We conducted a retrospective cohort study on adults who underwent transthoracic echocardiography (TTE) with LVGLS assessment across three Mayo Clinic centers (2017–2024) and who had RDW and serum albumin measured on the same day or within seven days. The RAR was calculated as RDW/albumin and categorized into the following tertiles: <2.93, 2.93–3.48, and >3.48. Impaired LVGLS was defined as >−18%. Associations between the RAR and outcomes were assessed using multivariable logistic regression (LVGLS) and Cox models (HF and mortality), adjusting for demographics and comorbidities. Results: Among 5069 patients, 39.7% had impaired LVGLS, and its prevalence increased across RAR tertiles (26.8%, 41.9%, and 51.1%). Adjusted odds ratios for impaired LVGLS were 1.74 and 2.30 for tertiles 2 and 3, respectively. A higher RAR was associated with increased risk of HF hospitalization (aHR 2.54 and 4.48) and all-cause mortality (aHR 2.39 and 7.30). These associations persisted after adjusting for LVGLS. The effect of the RAR on mortality was stronger in patients with normal LVGLS compared to those with impaired LVGLS (p for interaction = 0.0004). Conclusions: A higher RAR was associated with abnormal LVGLS, HF hospitalization, and all-cause mortality after adjustment for clinical risk factors. However, the RAR did not provide discriminative value beyond its individual components.
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Ahmed et al. (2026) conducted a cohort in Subclinical myocardial impairment (n=5,069). Higher red cell distribution width-albumin ratio (RAR) vs. Lowest RAR tertile (<2.93) was evaluated on Impaired LVGLS (>-18%) (OR 2.30). Higher red cell distribution width-albumin ratio (highest tertile) was associated with a significantly higher prevalence of impaired LVGLS compared to the lowest tertile (51.1% vs 26.8%; OR 2.30).
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