Anemia and Its Relationship to Clinical Outcome in Heart Failure

Anand, Inder; McMurray, John J.V.; Whitmore, James B.; Warren, Marshelle; Pham, Anh Nguyet; McCamish, Mark; Burton, Paul

doi:10.1161/01.cir.0000134279.79571.73

Cited by 365 publications

(286 citation statements)

References 23 publications

Supporting

Mentioning

256

Contrasting

Unclassified

Order By: Relevance

“…35 Along with vitamin D deficiency, low hemoglobin levels have been linked with poorer outcomes for patients with IHD as well as heart failure. [36][37][38] In IHD patients, anemia is an independent predictor of both short and long term mortality. 39 A 1-year follow up, multicenter study, done in three university hospitals in France which included 925 consecutive patients being admitted with PAD found that anemia was significantly and independently associated with death and amputation (HR 1.44 (1.15-1.80) p < 0.001).…”

Section: Discussionmentioning

confidence: 99%

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

et al. 2016

View full text Add to dashboard Cite

Background: End-stage renal failure (ESRF) and dialysis have been identified as a risk factor for lower limb amputations (LLAs). High rate of ESRF amongst the Australian population has been reported, however till date no study has been published identifying magnitude and risk factors of LLA in subjects on renal dialysis. Objective: The study aims to document trends in the prevalence and identify risk factors of nontraumatic LLA in Australian patients on dialysis. Methods: A retrospective review of all patients (218) ] p¼ 0.01). 75% of the amputees had aboriginal heritage. We also identified higher HbA1c and CRP levels as well as low serum albumin, hemoglobin and vitamin D levels to have a strong association with LLAs (p < 0.05). Conclusion: There is high prevalence of LLAs amongst Australian indigenous patients with diabetes on dialysis in North Queensland. Other strongly associated risk factors include history of foot ulceration, foot deformity and peripheral neuropathy as well as high HbA1c levels and low serum albumin levels.

show abstract

Section: Discussionmentioning

confidence: 99%

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The presence of anemia is associated with increased severity of HF [2,3], and higher rates of rehospitalization [4], and mortality [2][3][4][5][6]. Despite the evidence, however, the role of anemia as a risk factor has not yet been included in the American College of Cardiology, American Heart Association, or European Society of Cardiology guidelines on the assessment and management of heart failure patients [7,8].…”

Section: Introductionmentioning

confidence: 99%

Relationship of B‐type natriuretic peptide and anemia in patients with and without heart failure: A substudy from the Breathing Not Properly (BNP) Multinational Study

Omland

Knudsen

et al. 2005

American J Hematol

View full text Add to dashboard Cite

While anemia is a significant risk factor for poor outcomes in patients with heart failure (HF), it is not in defined guidelines for HF assessment. B-type natriuretic peptide (BNP) is a marker for diagnosis and management of patients with HF. We determined the incidence of anemia in patients with HF and the relationship between BNP and hemoglobin (Hgb) levels in patients with and without HF. Results from the Breathing Not Properly Multinational Trial consisted of 1586 patients presenting to the emergency department (ED) with dyspnea. Because renal insufficiency is a confounding variable for BNP, patients with a creatinine of ‡2.0 mg/dL were excluded. The remaining data were evaluated from 620 non-HF patients (337 M, 283 F) and 547 HF patients (299 M, 248 F). The New York Heart Association (NYHA) HF classification and ejection fraction by echocardiography were assessed for HF patients. Blood was tested for Hgb, BNP, and creatinine. Using World Health Organization criteria for anemia, we observed that HF patients in NYHA class III or IV had lower mean Hgb levels (12.5 g/dL, P < 0.05) and a higher incidence of anemia (48.2%, P < 0.05) than did HF patients in class I or II (13.4 g/dL and 33.9%, respectively). There was no correlation between Hgb and log BNP for females without HF or the aggregate of all HF patients. In contrast, a significant inverse correlation was observed for males without HF (P < 0.001). Although there were differences in the BMI, age, and estimated glomerular filtration rate (eGFR) versus Hgb observed in this group, the log BNP correlation remained significant after multivariate analysis. A significant inverse correlation for log BNP and Hgb were also observed for diastolic (EF ‡ 50) HF (P < 0.05) that was also not accounted for by the BMI, age, or eGFR. The presence of anemia is associated with worsening HF at ED presentation. For males without HF and diastolic HF patients of both genders, a low Hgb may be a confounding variable toward

show abstract

“…A nemia predicts outcomes of critically ill patients (1,2) and those with chronic diseases (3)(4)(5). Although anemia is prevalent in these common clinical settings, it is now appreciated that treatment of anemia by transfusion (6) or with erythropoiesis stimulating agents (4) does not necessarily improve mortality.…”

mentioning

confidence: 99%

Priming of hypoxia-inducible factor by neuronal nitric oxide synthase is essential for adaptive responses to severe anemia

Tsui

Marsden²,

Mazer³

et al. 2011

Proc. Natl. Acad. Sci. U.S.A.

102

View full text Add to dashboard Cite

Cells sense and respond to changes in oxygen concentration through gene regulatory processes that are fundamental to survival. Surprisingly, little is known about how anemia affects hypoxia signaling. Because nitric oxide synthases (NOSs) figure prominently in the cellular responses to acute hypoxia, we defined the effects of NOS deficiency in acute anemia. In contrast to endothelial NOS or inducible NOS deficiency, neuronal NOS (nNOS) −/− mice demonstrated increased mortality during anemia. Unlike wild-type (WT) animals, anemia did not increase cardiac output (CO) or reduce systemic vascular resistance (SVR) in nNOS −/− mice. At the cellular level, anemia increased expression of HIF-1α protein and HIF-responsive mRNA levels (EPO, VEGF, GLUT1, PDK1) in the brain of WT, but not nNOS −/− mice, despite comparable reductions in tissue PO 2 . Paradoxically, nNOS −/− mice survived longer during hypoxia, retained the ability to regulate CO and SVR, and increased brain HIF-α protein levels and HIF-responsive mRNA transcripts. Real-time imaging of transgenic animals expressing a reporter HIF-α(ODD)-luciferase chimeric protein confirmed that nNOS was essential for anemia-mediated increases in HIF-α protein stability in vivo. S -nitrosylation effects the functional interaction between HIF and pVHL. We found that anemia led to nNOS-dependent S -nitrosylation of pVHL in vivo and, of interest, led to decreased expression of GSNO reductase. These findings identify nNOS effects on the HIF/pVHL signaling pathway as critically important in the physiological responses to anemia in vivo and provide essential mechanistic insight into the differences between anemia and hypoxia.

show abstract

Anemia and Its Relationship to Clinical Outcome in Heart Failure

Cited by 365 publications

References 23 publications

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

Non-traumatic lower limb amputation in patients with end-stage renal failure on dialysis: an Australian perspective

Relationship of B‐type natriuretic peptide and anemia in patients with and without heart failure: A substudy from the Breathing Not Properly (BNP) Multinational Study

Priming of hypoxia-inducible factor by neuronal nitric oxide synthase is essential for adaptive responses to severe anemia

Contact Info

Product

Resources

About