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 (<Â 11Â g/dL), low (11â12 for females, 11â13 for males), normal (12â15 for females, 13â15 for males) and high (>Â 15) Hb, respectively. Results Median follow-up was 1363Â days (606â1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR)Â =Â 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 HRÂ =Â 0.549, low Hb HRÂ =Â 0.613, normal Hb HRÂ =Â 0.618, high Hb HRÂ =Â 0.542) and LVEF (very low Hb HRÂ =Â 0.49, low Hb HRÂ =Â 0.692, normal Hb HRÂ =Â 0.697, high Hb HRÂ =Â 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 HbÂ <Â 11Â 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.
|Titolo:||Heart failure and anemia : Effects on prognostic variables|
|Parole Chiave:||anemia; heart failure; prognosis; aged; anemia; carbon dioxide; cohort studies; comorbidity; exercise test; female; heart failure; hemoglobins; humans; italy; male; middle aged; multivariate analysis; prognosis; proportional hazards models; prospective studies; sodium; oxygen consumption; pulmonary ventilation; stroke volume; internal medicine|
|Settore Scientifico Disciplinare:||Settore MED/11 - Malattie dell'Apparato Cardiovascolare|
|Data di pubblicazione:||gen-2017|
|Data ahead of print / Data di stampa:||28-set-2016|
|Digital Object Identifier (DOI):||10.1016/j.ejim.2016.09.011|
|Appare nelle tipologie:||01 - Articolo su periodico|