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Erschienen in:
01.12.2015 | MULTIMEDIA REPORT
Anemia and its association with clinical outcome in heart failure patients undergoing cardiac resynchronization therapy
Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 3/2015
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Purpose
Although a substantial proportion of patients with heart failure (HF) have anemia, there is a paucity of data evaluating the impact of anemia on clinical outcome in CRT patients. Our goal was to examine the ability of baseline hemoglobin (Hb) level and change in Hb level over time to predict clinical 2-year outcome and echocardiographic response to CRT.
Methods
Three hundred consecutive CRT patients (median 72 years [interquartile range (IQR) 16 years], 19 % female) with baseline and follow-up hematological profiles available were examined. Baseline anemia was defined as Hb <12 g/dL in women and <13 g/dL in men, and patients were grouped into equal quartiles based on change in Hb. Two-year clinical outcome was determined using a composite endpoint that included HF hospitalization, left ventricular assist device (LVAD) placement, heart transplantation, and all-cause mortality. Echocardiographic reverse remodeling was examined at 6-month follow-up.
Results
One hundred fifty-one anemic patients were compared to 149 non-anemic patients. Changes in left ventricular dimensions and ejection fraction were similar for both groups. Univariate predictors of 2-year clinical outcome included baseline creatinine level, diuretic usage, and anemia; in multivariable regression, baseline anemia was an independent predictor for outcome (hazard ratio [HR] 1.79, 95 % confidence interval [CI] [1.22–2.63], p = 0.003). The quartile with the most negative change in Hb concentration over time (≤−1.00 g/dL) had poorer event-free 2-year survival (HR 1.84, CI [1.13–3.00], p = 0.014).
Conclusions
Baseline anemia and early postimplantation decline in Hb levels are associated with a worse 2-year prognosis in CRT patients, even though the magnitude of left ventricular reverse remodeling is similar compared to non-anemic patients.