Nicole Ebner1, Ewa A Jankowska2, Piotr Ponikowski2, Mitja Lainscak3, Sebastian Elsner4, Veronika Sliziuk4, Lisa Steinbeck4, Jennifer Kube4, Tarek Bekfani4, Nadja Scherbakov5, Miroslava Valentova6, Anja Sandek1, Wolfram Doehner5, Jochen Springer7, Stefan D Anker1, Stephan von Haehling8. 1. Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany. 2. Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Poland. 3. Department of Cardiology, General Hospital Celje, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. 4. Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany. 5. Center for Stroke Research Berlin, Charite University Medical School, Germany. 6. Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; 1st Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic. 7. Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany. 8. Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany. Electronic address: stephan.von.haehling@web.de.
Abstract
UNLABELLED: Anaemia and iron deficiency (ID) are important co-morbidities in patients with chronic heart failure (HF) and both may lead to reduced exercise capacity. METHODS: We enrolled 331 out-patients with stable chronic HF (mean age: 64 ± 11 years, 17% female, left ventricular ejection fraction [LVEF] 35 ± 13%, body mass index [BMI] 28.5 ± 5.2 kg/m(2), New York Heart Association [NYHA] class 2.2 ± 0.7, chronic kidney disease 35%, glomerular filtration rate 61.7 ± 20.1 mL/min). Anaemia was defined according to World Health Organization criteria (haemoglobin [Hb] < 13 g/dL in men, < 12 g/dL in women). ID was defined as serum ferritin < 100 μg/L or ferritin < 300 μg/L with transferrin saturation (TSAT) < 20%. Exercise capacity was assessed as peak oxygen consumption (peak VO2) by spiroergometry and 6-minute walk test (6MWT). RESULTS: A total of 91 (27%) patients died from any cause during a mean follow-up of 18 months. At baseline, 98 (30%) patients presented with anaemia and 149 (45%) patients presented with ID. We observed a significant reduction in exercise capacity in parallel to decreasing Hb levels (r = 0.24, p < 0.001). In patients with anaemia and ID (n = 63, 19%), exercise capacity was significantly lower than in patients with ID or anaemia only. Cox regression analysis showed that after adjusting for NYHA, age, hsCRP and creatinine anaemia is an independent predictor of mortality in patients with HF (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.33-0.97, p = 0.04). CONCLUSION: The impact of anaemia on reduced exercise capacity and on mortality is stronger than that of ID. Anaemia remained an independent predictor of death after adjusting for clinically relevant variables.
UNLABELLED: Anaemia and iron deficiency (ID) are important co-morbidities in patients with chronic heart failure (HF) and both may lead to reduced exercise capacity. METHODS: We enrolled 331 out-patients with stable chronic HF (mean age: 64 ± 11 years, 17% female, left ventricular ejection fraction [LVEF] 35 ± 13%, body mass index [BMI] 28.5 ± 5.2 kg/m(2), New York Heart Association [NYHA] class 2.2 ± 0.7, chronic kidney disease 35%, glomerular filtration rate 61.7 ± 20.1 mL/min). Anaemia was defined according to World Health Organization criteria (haemoglobin [Hb] < 13 g/dL in men, < 12 g/dL in women). ID was defined as serum ferritin < 100 μg/L or ferritin < 300 μg/L with transferrin saturation (TSAT) < 20%. Exercise capacity was assessed as peak oxygen consumption (peak VO2) by spiroergometry and 6-minute walk test (6MWT). RESULTS: A total of 91 (27%) patients died from any cause during a mean follow-up of 18 months. At baseline, 98 (30%) patients presented with anaemia and 149 (45%) patients presented with ID. We observed a significant reduction in exercise capacity in parallel to decreasing Hb levels (r = 0.24, p < 0.001). In patients with anaemia and ID (n = 63, 19%), exercise capacity was significantly lower than in patients with ID or anaemia only. Cox regression analysis showed that after adjusting for NYHA, age, hsCRP and creatinineanaemia is an independent predictor of mortality in patients with HF (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.33-0.97, p = 0.04). CONCLUSION: The impact of anaemia on reduced exercise capacity and on mortality is stronger than that of ID. Anaemia remained an independent predictor of death after adjusting for clinically relevant variables.
Authors: Laura S Redwine; Kathleen Wilson; Meredith A Pung; Kelly Chinh; Thomas Rutledge; Paul J Mills; Barbara Smith Journal: J Cardiopulm Rehabil Prev Date: 2019-11 Impact factor: 2.081
Authors: Danielle L Kirkman; Natalie Bohmke; Salvatore Carbone; Ryan S Garten; Paula Rodriguez-Miguelez; Robert L Franco; Jason M Kidd; Antonio Abbate Journal: Am J Physiol Renal Physiol Date: 2020-12-07