title: Prevalence, prognosis, and therapeutic implications of unrecognized left ventricular systolic dysfunction in patients with anemia and chronic kidney disease.
abstract: The prevalence and outcomes of unrecognized left ventricular dysfunction (ULVSD) in patients with anemia and chronic kidney disease (CKD) is not known. The authors determined whether anemia (hemoglobin <13 g/L) and CKD (glomerular filtration rate <60 mL/min) are risk factors for ULVSD (ejection fraction <35%, no known heart failure [HF]) and to determine its impact on clinical outcomes. A total of 1358 patients without history of HF undergoing gated myocardial perfusion single photon emission computed tomography for evaluation of suspected coronary artery disease were followed for a mean of 2.15 ± 0.8 years. End points were death and heart failure hospitalization (HFH). Patients were divided into 4 groups (I: no anemia/no CKD, n=752; II: CKD/no anemia, n=285; III: anemia/no CKD, n=153; IV: anemia+CKD, n=168). Compared with group I, LVSD was significantly more common in group IV (11.3% vs 4%; P=.0009). Death and HFH were significantly higher in group IV compared with group I (death rate for group I: 3.5% per year vs group IV: 12% per year; P<.0001) (HFH rate for group I: 1.5% per year vs group IV: 8% per year, P<.0001). Among patients with ejection fraction <35%, presence of anemia+CKD was associated with a relative risk of 2.48 (95% confidence interval, 1.13-5.4; P=.02) for death compared with group I. Among patients with ULVSD, only 65% were taking angiotensin enzyme inhibitors/angiotensin receptor blockers and β-blockers. ULVSD was almost 3 times more common in patients with anemia+CKD compared with those without and was associated with a significantly higher risk of death and HFH. It may therefore be beneficial to screen patients with anemia and CKD for ULVSD, since early therapy may improve outcomes.
authors.affiliation: Division of Cardiovascular Diseases, University of Cincinnati, College of Medicine, Cincinnati, OH, USA. bhattisa@ucmail.uc.edu
authors.forename: Sabha
authors.initials: S
authors.lastname: Bhatti
authors.forename: Abdul
authors.initials: A
authors.lastname: Hakeem
authors.forename: Kathryn S
authors.initials: KS
authors.lastname: Dillie
authors.forename: Jeffery R
authors.initials: JR
authors.lastname: Cook
authors.forename: Su Min
authors.initials: SM
authors.lastname: Chang
mesh_terms: D000704:Analysis of Variance; D000740:Anemia / Q000503:physiopathology*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016001:Confidence Intervals; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D012306:Risk; D018570:Risk Assessment; D012720:Severity of Illness Index; D013223:Statistics as Topic; D013318:Stroke Volume; D013599:Systole; D015899:Tomography, Emission-Computed, Single-Photon; D014481:United States / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000453:epidemiology* / Q000503:physiopathology; D016277:Ventricular Function, Left
chemical_list: D000959:Antihypertensive Agents