Abstract 2362: High Serum Erythropoietin Level is Associated with Poor Prognosis in Heart Failure Patients with Systolic Dysfunction but not with Preserved Systolic Function

Abstract

Introduction: It is known that serum levels of erythropoietin (EPO) are elevated in patients with chronic heart failure (CHF) and correlate with the severity of CHF. Serum EPO levels have been examined in stable CHF patients with LV systolic dysfunction (LVSDF) but not in patients with preserved LV ejection fraction (PLVEF). Moreover, the data about EPO are also lacking in acute decompensated HF (ADHF) patients. Hypothesis: Serum EPO levels may be different between patients with LVSDF and with PLVEF, and between patients in an acute decompensated state and in a stable, compensated state. Methods: We studied 52 patients who were admitted to our hospital with ADHF (NYHA functional class of III or IV). There were 22 females, and mean age was 73 years. They were divided into 2 groups: LVSDF (LV ejection fraction (EF) < 45%, n = 37) and PLVEF (LVEF ≥ 45%, n = 15). Serum EPO, hemoglobin (Hb) and plasma brain natriuretic peptide (BNP) levels were measured on admission and after treatment. The estimated glomerular filtration rate (eGFR) was calculated using the Modification of Diet in Renal Disease Study equation. Results: On admission, serum EPO levels were higher in the LVSDF than in the PLVEF groups (84 ± 12 vs. 55 ± 9 mU/ml, p < 0.05). After treatment, NYHA functional classes equally improved to I or II, and serum EPO and plasma BNP levels decreased in both groups (LVSDF: 31 ± 5 vs. 84 ± 12 mU/ml, p < 0.05; 526 ± 82 vs. 1134 ± 163 pg/ml, p < 0.05; PLVEF: 24 ± 4 vs. 55 ± 9 mU/ml, p < 0.05; 240 ± 53 vs. 523 ± 87 pg/ml, p < 0.05). The Hb levels and eGFR were not different between the groups on admission. When plasma BNP levels were matched between the 2 groups, the same tendency was observed in the levels of EPO. The higher EPO levels (> 50 mU/ml) in ADHF were associated with higher incidence of cardiac death or HF hospitalizations (log-rank test, p < 0.05) only in the LVSDF group. Conclusions: Serum EPO levels were higher in patients with LVSDF than in those with PLVEF in ADHF. Elevated serum EPO levels were associated with a poor prognosis in the LVSDF group, but not in the PLVEF group. Serum EPO levels may be useful prognostic value only in HF patients with LVSDF.