The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction.

Anita Pintér,Béla Merkely,Eperke Dóra Merkel,Annamária Kosztin,Bálint Károly Lakatos,Dávid Becker,Attila Kovács,Boglárka Veres,Walter Richard Schwertner,Richard Masszi,Luca Katalin Kuthi,Anett Behon

doi:10.3390/diagnostics12020517

Abstract

Data on the relevance of anemia in heart failure (HF) patients with an ejection fraction (EF) > 40% by subgroup—preserved (HFpEF), mildly reduced (HFmrEF) and the newly defined recovered EF (HFrecEF)—are scarce. Patients with HF symptoms, elevated NT-proBNP, EF ≥ 40% and structural abnormalities were registered in the HFpEF-HFmrEF database. We described the outcome of our HFpEF-HFmrEF cohort by the presence of anemia. Additionally, HFrecEF patients were also selected from HFrEF patients who underwent resynchronization and, as responders, reached 40% EF. Using propensity score matching (PSM), 75 pairs from the HFpEF-HFmrEF and HFrecEF groups were matched by their clinical features. After PMS, we compared the survival of the HFpEF-HFmrEF and HFrecEF groups. Log-rank, uni-and multivariate regression analyses were performed. From 375 HFpEF-HFmrEF patients, 42 (11%) died during the median follow-up time of 1.4 years. Anemia (HR 2.77; 95%CI 1.47–5.23; p < 0.01) was one of the strongest mortality predictors, which was also confirmed by the multivariate analysis (aHR 2.33; 95%CI 1.21–4.52; p = 0.01). Through PSM, the outcomes for HFpEF-HFmrEF and HFrecEF patients with anemia were poor, exhibiting no significant difference. In HFpEF-HFmrEF, anemia was an independent mortality predictor. Its presence multiplied the mortality risk in those with EF ≥ 40%, regardless of HF etiology.

Highlights

Heart failure (HF) affects 1–2% of the adult population in developed countries, and the prevalence of HF is reaching ≥10% among the elderly [1]
Activation of the sympathetic and renin-angiotensin-aldosterone system may have a negative effect on cardiac function through cardiac fibrosis, myocardial cell death, left ventricular hypertrophy and dilatation, which can lead to a decreased left ventricular ejection fraction [9,10] and related high HF biomarkers [11]
375 patients were analyzed in the HFpEF-HFmrEF patient group

Summary

Introduction

Heart failure (HF) affects 1–2% of the adult population in developed countries, and the prevalence of HF is reaching ≥10% among the elderly [1]. In patients with HF, 22–73% of subjects present with a preserved ejection fraction (HFpEF), which has a wide range of prevalence based on the varying definitions of the disease [1] Such patients often suffer from multiple concomitant diseases, which adversely affect their outcomes [2,3,4,5]. Activation of the sympathetic and renin-angiotensin-aldosterone system may have a negative effect on cardiac function through cardiac fibrosis, myocardial cell death, left ventricular hypertrophy and dilatation, which can lead to a decreased left ventricular ejection fraction [9,10] and related high HF biomarkers (such as natriuretic peptides or troponin levels) [11]. The presence of anemia alone is associated with poor outcomes in all types of HF, regardless of the left ventricular ejection fraction (LVEF) [6,7,13,14,15]

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