title: Anemia in adults with congenital heart disease relates to adverse outcome.
abstract: OBJECTIVE
  To assess the relation of anemia in noncyanotic adults with congenital heart disease (ACHD) to functional capacity and mortality.
  
  
  BACKGROUND
  Anemia is common in acquired heart failure and affects prognosis. The presence of anemia and its relation to outcome in ACHD remain unknown.
  
  
  METHODS
  Data were collected on consecutive noncyanotic ACHD patients attending our tertiary center between 2001 and 2006 in whom hemoglobin concentration was measured. Anemia was defined as hemoglobin concentration <13 g/dl in males and <12 g/dl in females. Cyanotic patients were excluded to avoid confounding from secondary erythrocytosis.
  
  
  RESULTS
  Overall, 830 noncyanotic ACHD patients (age 36.5 +/- 15.0 years, 49.6% male) fulfilled the inclusion criteria. The prevalence of anemia was 13.1% and was highest in patients with congenitally corrected transposition of great arteries and Ebstein anomaly of the tricuspid valve. Anemic patients were more likely to be receiving diuretics (p < 0.0001) and have a lower mean corpuscular volume (p = 0.0001), with a trend toward a higher New York Heart Association functional class (p = 0.06). During a median follow-up of 47 months, 55 patients died. Anemic patients had a 3-fold higher mortality risk compared with nonanemic patients, even after propensity score adjustment for clinical variables such as systemic ventricular function, renal impairment, and diuretic therapy (adjusted hazard ratio: 3.00; 95% confidence interval: 1.46 to 6.13).
  
  
  CONCLUSIONS
  Anemia is not uncommon in ACHD patients attending tertiary services and is associated with a 3-fold increased risk of death. Screening for anemia should be part of the routine assessment of ACHD patients for risk stratification and treatment when correctable causes are identified.
authors.affiliation: Adult Congenital Heart Centre and Centre for Pulmonary Hypertension, Royal Brompton Hospital, London, United Kingdom. k.dimopoulos02@ic.ac.uk
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Dimopoulos
authors.forename: Gerhard-Paul
authors.initials: GP
authors.lastname: Diller
authors.forename: Georgios
authors.initials: G
authors.lastname: Giannakoulas
authors.forename: Ricardo
authors.initials: R
authors.lastname: Petraco
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Chamaidi
authors.forename: Evaggelia
authors.initials: E
authors.lastname: Karaoli
authors.forename: Michael
authors.initials: M
authors.lastname: Mullen
authors.forename: Lorna
authors.initials: L
authors.lastname: Swan
authors.forename: Massimo F
authors.initials: MF
authors.lastname: Piepoli
authors.forename: Philip A
authors.initials: PA
authors.lastname: Poole-Wilson
authors.forename: Darrel P
authors.initials: DP
authors.lastname: Francis
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gatzoulis
mesh_terms: D000293:Adolescent; D000328:Adult; D000740:Anemia / Q000453:epidemiology*; D004437:Ebstein Anomaly / Q000601:surgery; D005260:Female; D006330:Heart Defects, Congenital / Q000453:epidemiology* / Q000401:mortality; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D018570:Risk Assessment; D014188:Transposition of Great Vessels / Q000601:surgery; D055815:Young Adult
chemical_list: D006454:Hemoglobins