title: Association of anemia and long-term survival in patients with pulmonary hypertension.
abstract: BACKGROUND
  Anemia is a marker of worsened clinical outcome in patients with heart failure from left ventricular dysfunction. Pulmonary hypertension often results in right ventricular dysfunction. Accordingly we sought to examine the association of hemoglobin levels and long-term all-cause mortality in a cohort of patients with pulmonary hypertension.
  
  
  METHODS
  Baseline demographic information, clinical characteristics and fasting blood work were obtained in a cohort of 145 patients with pulmonary hypertension referred for pulmonary vasodilator testing. Data was retrospectively analyzed with Cox-proportional hazards analysis.
  
  
  RESULTS
  Baseline characteristics of the cohort included age (mean±SD) 55.8±14.6 years, 75% women, 50% with idiopathic pulmonary hypertension, mean pulmonary artery pressure 46.1±14.2 mm Hg and arterial O(2) saturation 91±6 %. The most commonly utilized pulmonary hypertension specific therapeutic agents in descending order of frequency were epoprostenol (27%), sildenafil (21%), bosentan (17%), and treprostinil (6%). Over a median follow-up of 2.1 years, there were 39 deaths (26.9%). Patients who died had significantly lower hemoglobin levels than those survived (12.2±2.3 vs. 13.7±2.0, p<0.001). After adjustment for known predictors of death and pulmonary hypertension etiology, anemic patients were 3.3 times more likely to die than non-anemic patients (95% CI [1.43-7.51], p=0.005).
  
  
  CONCLUSIONS
  Hemoglobin levels closely parallel survival in pulmonary hypertension. Modification of anemia in this disorder could alter the clinical course and calls for further research in this area.
authors.affiliation: Division of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, United States. krasusr@ccf.org
authors.forename: Richard A
authors.initials: RA
authors.lastname: Krasuski
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Hart
authors.forename: Brad
authors.initials: B
authors.lastname: Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Wang
authors.forename: J Kevin
authors.initials: JK
authors.lastname: Harrison
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Bashore
mesh_terms: D000328:Adult; D000368:Aged; D000740:Anemia / Q000097:blood / Q000401:mortality* / Q000503:physiopathology; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006976:Hypertension, Pulmonary / Q000097:blood* / Q000401:mortality* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D017741:Survivors
chemical_list: D006454:Hemoglobins