Hemoglobin Levels Predict Exercise Performance, ST‐Segment Depression, and Outcome in Patients Referred for Routine Exercise Treadmill Testing

Abstract

Background: While the role of hemoglobin in heart failure and renal disease has been investigated, little is known about its effect on clinical exercise test performance and mortality in patients referred for routine exercise treadmill testing (ETT). Hypothesis: Patients with low hemoglobin will have poor exercise capacity and would be at increased risk of mortality and cardiovascular (CV) events. Methods: Clinical variables, laboratory values, and exercise treadmill data were obtained for 1,799 patients referred for routine ETT from 1997 to 2004. All-cause mortality was obtained from the United States Social Security death index and autopsy reports or clinical notes were used to determine CV events and mortality. P values <0.05 were considered significant. Results: Our population had a mean age of 58±12 years, 16% had diabetes, 53% had hypertension, 35% had hypercholesterolemia, and 67% had a history of smoking. During follow-up, 10.3% of patients died, 3.9% of patients died of CV causes, and 11.6% had cardiovascular events. Anemic patients (hemoglobin [Hgb] <13 g/dL) achieved lower metabolic equivalents (METs) than nonanemic patients and had more ST-segment depression (15.5% versus 8.6%, p<0.004). Proportional hazard analysis demonstrated that hemoglobin was significantly associated with all-cause mortality (p<0.0007), CV mortality (p<0.009), and CV events (p<0.01).Kaplan-Meier survival analysis demonstrated that anemic patients had significantly higher mortality and CV events. Conclusion: Hemoglobin is significantly associated with exercise performance, ST-segment depression during ETT, mortality, and cardiovascular events. The incorporation of hemoglobin may add diagnostic and prognostic information to ETT.

Trends in the Use of Guideline-Recommended Medications and In-Hospital Mortality of Patients with Acute Myocardial Infarction in a Chinese Population

“…Patients with hyperlipidemia had lower in-hospital mortality in our study, which was also found in Gierlotka et al’s study [ 21 ]. Some studies [ 28 , 29 ] had shown the cholesterol paradox (higher low density lipoprotein levels were related to better clinical outcomes) in AMI patients. Wang [ 29 ] indicated that the paradox might be related to confounding, where this protective association persisted after multifactor adjustment, so it was attributed to some unmeasured confounders that may not be captured by observational databases.…”

“…Some studies [ 28 , 29 ] had shown the cholesterol paradox (higher low density lipoprotein levels were related to better clinical outcomes) in AMI patients. Wang [ 29 ] indicated that the paradox might be related to confounding, where this protective association persisted after multifactor adjustment, so it was attributed to some unmeasured confounders that may not be captured by observational databases. In addition, AMI patients with hyperlipidemia are younger (which was verified in our database) [ 29 ], and hyperlipidemia may reflect better nutritional and health status, which are more likely to associate with better tolerance of acute medical stress.…”

Correlation of Elevated Serum Serotonin Levels with Regular Aerobic Exercise is Associated with Alterations in Monocyte Count and Hemoglobin Levels during Winter Season

“…Therefore, exercise regulate the expression of certain genes of monocytes in a way that could limit pro-inflammatory function and drive monocytes to prevent atherosclerosis (Radom-Aizik et al, 2014). Finally, although many studies showed a positive association between hemoglobin levels and exercise performance (Lipinski et al, 2009) this is first study that indicate the effect of hemoglobin levels on serum serotonin in exercising individuals. Strengths of this study also include homogenous sample in the terms of age, gender and ethnicity, also the blood samples were collected in the time out of exercise during depressive season.…”

The proper care for elderly cardiac patients before rehabilitation

“…[13][14][15] Another proof of the relationship found in the EU-CaRE study is a publication which concluded that anaemic patients (haemoglobin < 13 g/dL) achieved lower metabolic equivalents than non-anaemic patients and had more ST-segment depression (15.5% vs. 8.6%, p < 0.004). 16 The link between age, heart failure, ejection fraction, forced expiratory volume in the first second and exercise capacity has been well established in previous similar studies. Other not well-studied comorbidities with strong association with future rehabilitation were found here: nephropathy, peripheral arterial disease, atrial fibrillation, diabetes mellitus, obesity and inactivity.…”