Background. Most of the studies done on adults showed that red cell distribution width (RDW) can be used as a prognostic marker in patients with chronic heart failure. However, RDW has not been tested in children with heart failure. Methods and Results. 31 children with heart failure admitted to Cardiology Unit, Tanta University Hospital, during the period of January 2012 to December 2012 were included in this study, RDW as a component of routine blood count was evaluated and correlated to the echocardiographic parameters of left ventricle. The mean age of our cohort was 16.16？±？14.97 months, congenital heart disease with left-to-right shunt represented 58.1% of the underlying causes of heart failure while dilated cardiomyopathy made 41.9%. The mean hemoglobin level was 9.14？±？1.18？gm/dL; RDW level ranged from 10.7% to 27.7% with a mean of 16.01？±？3.34. Hemoglobin was significantly correlated with RDW at any level. For the echo parameters, at cutoff point of 16.4%, RDW was significantly correlated with fraction shortening (FS), and A, E/A ratio, but it was not correlated with LVEDD, LVESD, and E/é at the same cutoff level. Conclusion. RDW, a simple, available test, can be used as a marker for the left ventricular function in children with heart failure until an echocardiography assessment for the patients is done. 1. Background Red cell distribution width (RDW) measures the variation in the size of erythrocytes. It has been used to differentiate iron deficiency anemia from thalassemia trait, where increased RDW is associated with iron deficiency anemia [1, 2]. The association between anemia and cardiovascular outcome has been studied in the adult population. RDW has been recently discovered as a new marker in heart failure. It was found that increased RDW was associated with increased morbidity and mortality in chronic heart failure [3]. There is no definite pathophysiology explaining this association. Several factors may be proposed including inflammation, nutritional deficiencies, and inadequate production of erythropoietin [4–6]. Congestive heart failure is the most common cause for admission to the Pediatric Cardiology Unit at Tanta University Hospital. Congenital heart diseases with left-to-right shunt as VSD and PDA represent the majority of cases with heart failure; acute exacerbation of chronic heart failure in children with dilated cardiomyopathy forms another group. Several cardiac biomarkers have been tested as predictors for the severity of heart failure including brain natriuretic peptide, N-terminal pro-BNP (NT-proBNP), and cardiac
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