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

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.

Carbohydrate antigen 125: a useful marker of congestion, fibrosis, and prognosis in heart failure with preserved ejection fraction

“…This inflammatory and congestive environment may also explain the lower haemoglobin levels in patients with high CA 125 levels. Certainly, anaemia is due to multiple factors in HFpEF, which encompass conditions related to iron deficiency, dependency on erythropoietin with chronic kidney disease, inflammation, and volume overload, probably explaining the elevated CA 125 levels 32 …”

“…Certainly, anaemia is due to multiple factors in HFpEF, which encompass conditions related to iron deficiency, dependency on erythropoietin with chronic kidney disease, inflammation, and volume overload, probably explaining the elevated CA 125 levels. 32 Additionally, our study demonstrated for the first time in a chronic HFpEF patient population a positive correlation be-CV, cardiovascular; ECV, extracellular volume; EDV, end-diastolic volume; eGFR, estimated glomerular filtration rate; eSPAP, estimated systolic pulmonary artery pressure; FGF-23, fibroblast growth factor 23; HDL-C, high-density lipoprotein cholesterol; HFpEF, heart failure with preserved ejection fraction; hsTnT, high-sensitivity troponin T; IQR, inter-quartile range; LA, left atrial; LDL-C, low-density lipoprotein cholesterol; LV, left ventricular; MRA, mineralocorticoid receptor antagonist; NT-proBNP, N-terminal pro-brain natriuretic peptide; NYHA, New York Heart Association; RV, right ventricular; ST2, suppression of tumourigenicity 2; TAPSE, tricuspid annular plane systolic excursion. Values are reported as means ± standard deviations or medians and IQRs (IQR 0.25-0.75).…”

Anaemia and Congestion in Heart Failure: Correlations and Prognostic Role

“…Anaemia is a crucial finding in patients suffering from HF [ 1 , 30 , 31 ]. Despite many studies correlating anaemia with the prognosis of patients with HF [ 31 , 32 , 33 , 34 ], there is a paucity of data related to the interplay between anaemia and congestion, i.e., the most important clinical feature of patients with HF [ 15 , 16 , 17 , 18 ].…”

Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF

“…Anemia, affecting 15–20% of HFpEF patients, reduces oxygen delivery to tissues, increases cardiac output, and contributes to volume overload and left ventricular remodeling. 28) …”