Erythropoietin levels in heart failure after an acute myocardial infarction: determinants, prognostic value, and the effects of captopril versus losartan.
BACKGROUND
In patients with chronic heart failure, erythropoietin (Epo) levels are increased and related to a poor prognosis. Furthermore, Epo levels in these patients show a weak correlation with hemoglobin levels.


METHODS
This is a retrospective analysis of a subgroup of the OPTIMAAL (Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan) trial in which serum Epo levels were measured at baseline, at 1 month, and at 1 and 2 years in 224 patients with an acute myocardial infarction complicated by signs or symptoms of heart failure. We investigated the determinants and the prognostic role of elevated Epo levels in these patients, and we studied the change in Epo levels by either captopril or losartan.


RESULTS
The correlation between Epo and hemoglobin at baseline (r = 0.348, P < .001) and after 1 month (r = 0.272, P < .001) disappeared after 1 year of follow up (r = 0.129, P = .102). At 1 year, C-reactive protein was the only factor associated with Epo levels. Higher Epo levels at baseline were independently related to a higher mortality during 2 years of follow-up (hazard ratio 2.84, P = .014). In the captopril group, logEpo levels decreased from 1.19 (+/-0.26) to 0.95 (+/-0.20) mIU/mL, and in the losartan group from 1.19 (+/-0.27) to 1.01 (+/-0.17) mIU/mL (P = .036 between groups).


CONCLUSIONS
In this substudy of the OPTIMAAL trial, the correlation between Epo and hemoglobin disappeared in early post-acute myocardial infarction heart failure patients. Furthermore, elevated Epo levels at baseline predicted increased mortality.
Belonje
Anne M S
AM
Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
Westenbrink
B Daan
BD
Voors
Adriaan A
AA
von Haehling
Stephan
S
Ponikowski
Pjotr
P
Anker
Stefan D
SD
van Veldhuisen
Dirk J
DJ
Dickstein
Kenneth
K
D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002216:Captopril / Q000627:therapeutic use*; D004921:Erythropoietin / Q000097:blood*; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D009203:Myocardial Infarction / Q000097:blood* / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies
D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D004921:Erythropoietin; D002216:Captopril; D019808:Losartan