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.
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 anemicpatients were compared to 149 non-anemicpatients. 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-anemicpatients.
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; Michael J Blaha; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Rachel H Mackey; David J Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Robert W Neumar; Graham Nichol; Dilip K Pandey; Nina P Paynter; Matthew J Reeves; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2013-12-18 Impact factor: 29.690
Authors: Michele Brignole; Angelo Auricchio; Gonzalo Baron-Esquivias; Pierre Bordachar; Giuseppe Boriani; Ole-A Breithardt; John Cleland; Jean-Claude Deharo; Victoria Delgado; Perry M Elliott; Bulent Gorenek; Carsten W Israel; Christophe Leclercq; Cecilia Linde; Lluís Mont; Luigi Padeletti; Richard Sutton; Panos E Vardas Journal: Europace Date: 2013-06-24 Impact factor: 5.214
Authors: Eileen O'Meara; Jean L Rouleau; Michel White; Karine Roy; Lucie Blondeau; Anique Ducharme; Paul-Eduard Neagoe; Martin G Sirois; Joël Lavoie; Normand Racine; Mark Liszkowski; François Madore; Jean-Claude Tardif; Simon de Denus Journal: Circ Heart Fail Date: 2014-07-15 Impact factor: 8.790
Authors: Jean-Claude Daubert; Leslie Saxon; Philip B Adamson; Angelo Auricchio; Ronald D Berger; John F Beshai; Ole Breithard; Michele Brignole; John Cleland; David B Delurgio; Kenneth Dickstein; Derek V Exner; Michael Gold; Richard A Grimm; David L Hayes; Carsten Israel; Christophe Leclercq; Cecilia Linde; Joann Lindenfeld; Bela Merkely; Lluis Mont; Francis Murgatroyd; Frits Prinzen; Samir F Saba; Jerold S Shinbane; Jagmeet Singh; Anthony S Tang; Panos E Vardas; Bruce L Wilkoff; Jose Luis Zamorano Journal: Heart Rhythm Date: 2012-09 Impact factor: 6.343
Authors: Tamara B Horwich; Gregg C Fonarow; Michele A Hamilton; W Robb MacLellan; Jeff Borenstein Journal: J Am Coll Cardiol Date: 2002-06-05 Impact factor: 24.094
Authors: John G F Cleland; Jean-Claude Daubert; Erland Erdmann; Nick Freemantle; Daniel Gras; Lukas Kappenberger; Luigi Tavazzi Journal: N Engl J Med Date: 2005-03-07 Impact factor: 91.245
Authors: Eileen O'Meara; Tim Clayton; Margaret B McEntegart; John J V McMurray; Chim C Lang; Simon D Roger; James B Young; Scott D Solomon; Christopher B Granger; Jan Ostergren; Bertil Olofsson; Eric L Michelson; Stuart Pocock; Salim Yusuf; Karl Swedberg; Marc A Pfeffer Journal: Circulation Date: 2006-02-13 Impact factor: 29.690
Authors: Guido Boerrigter; Lisa C Costello-Boerrigter; William T Abraham; Martin G St John Sutton; Denise M Heublein; Kristin M Kruger; Michael R S Hill; Peter A McCullough; John C Burnett Journal: J Card Fail Date: 2008-05-27 Impact factor: 5.712