Heart failure and anemia: Effects on prognostic variables.
BACKGROUND
Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown.


METHODS
Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively.


RESULTS
Median follow-up was 1363days (606-1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR)=0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups separately, peakVO2(very low Hb HR=0.549, low Hb HR=0.613, normal Hb HR=0.618, high Hb HR=0.542) and LVEF (very low Hb HR=0.49, low Hb HR=0.692, normal Hb HR=0.697, high Hb HR=0.694) maintained their prognostic roles. High VE/VCO2slope was associated with poor prognosis only in patients with low and normal Hb.


CONCLUSIONS
Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO2and LVEF, but not VE/VCO2slope, maintain their prognostic power also in HF patients with Hb<11g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown.
Centro Cardiologico Monzino, IRCCS, Milano, Italy; Unità Operativa Cardiologia Riabilitativa, Ospedale S. Giuseppe, Multimedica Spa, IRCCS, Milano, Italy; Scuola Superiore S. Anna, Pisa, Italy.
Gaia
G
Cattadori
Centro Cardiologico Monzino, IRCCS, Milano, Italy; Dipartimento di Scienze Cliniche e di Comunità, Sezione Cardiovascolare, Università di Milano, Italy. Electronic address: piergiuseppe.agostoni@unimi.it.
Piergiuseppe
P
Agostoni
Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy.
Ugo
U
Corrà
Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
Gianfranco
G
Sinagra
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Fabrizio
F
Veglia
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Elisabetta
E
Salvioni
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Alice
A
Bonomi
Division of Cardiology, "S. Maugeri" Foundation, Institute of Cassano Murge, IRCCS, Bari, Italy.
Rocco
R
La Gioia
UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy.
Angela B
AB
Scardovi
UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy.
Alessandro
A
Ferraironi
Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
Michele
M
Emdin
Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Marco
M
Metra
Centro Cardiovascolare, Azienda per i Servizi Sanitari n°1, Trieste, Italy.
Andrea
A
Di Lenarda
Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
Giuseppe
G
Limongelli
Fondazione Salvatore Maugeri, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, IRCCS, Tradate, Italy.
Rosa
R
Raimondo
Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy.
Federica
F
Re
Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, Milano, Italy.
Marco
M
Guazzi
Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy.
Romualdo
R
Belardinelli
Dept of Clinical Medicine and Prevention, University of Milano Bicocca & Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milano, Italy.
Gianfranco
G
Parati
Dept of Clinical Medicine and Prevention, University of Milano Bicocca & Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milano, Italy.
Sergio
S
Caravita
Dipartimento di Medicina Clinica e Molecolare, "Sapienza" Università degli Studi di Roma, Roma, Italy.
Damiano
D
Magrì
Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Carlo
C
Lombardi
Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy.
Maria
M
Frigerio
Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy.
Fabrizio
F
Oliva
Unità Operativa Cardiologia Riabilitativa, Ospedale S. Giuseppe, Multimedica Spa, IRCCS, Milano, Italy.
Davide
D
Girola
Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy.
Alessandro
A
Mezzani
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Stefania
S
Farina
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Massimo
M
Mapelli
Division of Cardiology, "S. Maugeri" Foundation, Institute of Cassano Murge, IRCCS, Bari, Italy.
Domenico
D
Scrutinio
Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy.
Giuseppe
G
Pacileo
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Anna
A
Apostolo
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
AnnaMaria
A
Iorio
IRCCS SDN Istituto di Ricerca, Napoli, Italy.
Stefania
S
Paolillo
Dipartimento di Scienze Biomediche Avanzate, Università Federico II Napoli, Italy.
Pasquale Perrone
PP
Filardi
IRCCS SDN Istituto di Ricerca, Napoli, Italy.
Paola
P
Gargiulo
Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan, IRCCS, Milan, Italy.
Maurizio
M
Bussotti
Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan, IRCCS, Milan, Italy.
Giovanni
G
Marchese
Department of Cardiology, University of Foggia, Foggia, Italy.
Michele
M
Correale
Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesioloigiche e Geriatriche, "Sapienza", Rome University, Rome, Italy.
Roberto
R
Badagliacca
Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesioloigiche e Geriatriche, "Sapienza", Rome University, Rome, Italy.
Susanna
S
Sciomer
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Pietro
P
Palermo
Centro Cardiologico Monzino, IRCCS, Milano, Italy.
Mauro
M
Contini
Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy.
Pantaleo
P
Giannuzzi
Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
Elisa
E
Battaia
Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy.
Mariantonietta
M
Cicoira
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy.
Francesco
F
Clemenza
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy.
Chiara
C
Minà
UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy.
Simone
S
Binno
Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy.
Claudio
C
Passino
UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy.
Massimo F
MF
Piepoli
D000368:Aged; D000740:Anemia / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology; D002245:Carbon Dioxide; D015331:Cohort Studies; D015897:Comorbidity; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000453:epidemiology / Q000401:mortality* / Q000503:physiopathology; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010101:Oxygen Consumption; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012123:Pulmonary Ventilation; D012964:Sodium / Q000097:blood; D013318:Stroke Volume
D006454:Hemoglobins; D002245:Carbon Dioxide; D012964:Sodium
Anemia; Heart failure; Prognosis