Effects of beta-erythropoietin treatment on left ventricular remodeling, systolic function, and B-type natriuretic peptide levels in patients with the cardiorenal anemia syndrome.
BACKGROUND
Although anemia is frequently found in congestive heart failure (CHF), little is known about the effect of its correction with erythropoietin (EPO) on cardiac structure and function.


OBJECTIVE
The present study examines in patients with advanced CHF, chronic renal insufficiency, and anemia the effects of beta-EPO on left ventricular (LV) systolic diameter and volume (LVSD and LVSV), LV diastolic diameter and volume (LVDD and LVDV), LV mass, LV ejection fraction (LVEF), pulmonary artery pressure (PAP), and B-type natriuretic peptide (BNP) levels.


METHODS
Fifty-one consecutive subjects affected with advanced CHF and anemia were studied. We performed a randomized double-blind controlled study of correction of anemia with subcutaneous EPO for 4 months (group A, 26 patients) using saline as the placebo in the control group (group B, 25 patients). We then maintained the EPO treatment in the treated group for another 8 months. Both groups received oral iron throughout the total 12-month period. Echocardiographic evaluation, BNP levels, and hematological parameters are reported at 4 and 12 months.


RESULTS
The patients in group A during the double-blind phase (4 months) demonstrated an increase in LVEF and mild reduction in LVSD and LVSV with respect to baseline and to group B with no differences in PAP, LVDD, and LVDV. Over the 12-month period, the hemoglobin increased from 10.40.6 to 12.4 +/- 0.8 g/dL (P < .01) in group A but did not change in group B. Compared with group B, group A had lower LVDD, LVSD, LVDV, LVSV, LV mass, PAP, and BNP and higher LVEF. The serum creatinine and creatinine clearance remained unchanged in the 2 groups.


CONCLUSIONS
In anemic patients with CHF, correction of anemia with EPO and oral iron over 1 year lead to an improvement in LV systolic function, LV remodeling, BNP levels, and PAP compared with a control group in which only oral iron was used.
Palazzuoli
Alberto
A
Department of Internal Medicine and Metabolic Diseases, Section of Cardiology, Le Scotte Hospital, University of Siena, Siena, Italy. palazzuoli2@unisi.it
Silverberg
Donald S
DS
Iovine
Francesca
F
Calabrò
Anna
A
Campagna
Maria S
MS
Gallotta
Maddalena
M
Nuti
Ranuccio
R
D000368:Aged; D000740:Anemia / Q000503:physiopathology*; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D004921:Erythropoietin / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D009200:Myocardial Contraction / Q000187:drug effects*; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011994:Recombinant Proteins; D013318:Stroke Volume / Q000187:drug effects; D013577:Syndrome; D020257:Ventricular Remodeling / Q000187:drug effects*
D011994:Recombinant Proteins; D004921:Erythropoietin; D020097:Natriuretic Peptide, Brain; D003404:Creatinine