Highlights
- •Anemia is frequent in HF patients.
- •Little is known on how to manage HF prognostic parameters in anemic HF patients.
- •Cardiopulmonary exercise evaluation can be safely performed in anemic HF patients.
- •Cardiopulmonary exercise provides prognostic information in anemic HF patients.
- •However VE/VCO2 slope loses its prognostic power in patients with Hb < 11.0 g/dL.
Abstract
Background
Anemia is frequent in heart failure (HF), and it is associated with higher mortality.
The predictive power of established HF prognostic parameters in anemic HF patients
is unknown.
Methods
Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data
were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248
(6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (<11 g/dL), low (11–12 for females, 11–13 for males), normal (12–15 for females, 13–15
for males) and high (>15) Hb, respectively.
Results
Median follow-up was 1363 days (606–1883). CPETs were always performed safely. Hb was related to prognosis (Hazard
ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak
oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and
Hb were independently related to prognosis in the entire population. Considering Hb
groups separately, peakVO2 (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb.
Conclusions
Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb < 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb.
However, the prognostic effect of an anemia-oriented follow-up is unknown.
Keywords
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Article info
Publication history
Published online: September 28, 2016
Accepted:
September 14,
2016
Received in revised form:
July 21,
2016
Received:
April 26,
2016
Footnotes
☆Disclosure: none declared.
Identification
Copyright
© 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
