Gaia Cattadori1, Piergiuseppe Agostoni2, Ugo Corrà3, Gianfranco Sinagra4, Fabrizio Veglia5, Elisabetta Salvioni5, Alice Bonomi5, Rocco La Gioia6, Angela B Scardovi7, Alessandro Ferraironi7, Michele Emdin8, Marco Metra9, Andrea Di Lenarda10, Giuseppe Limongelli11, Rosa Raimondo12, Federica Re13, Marco Guazzi14, Romualdo Belardinelli15, Gianfranco Parati16, Sergio Caravita16, Damiano Magrì17, Carlo Lombardi9, Maria Frigerio18, Fabrizio Oliva18, Davide Girola19, Alessandro Mezzani3, Stefania Farina5, Massimo Mapelli5, Domenico Scrutinio6, Giuseppe Pacileo11, Anna Apostolo5, AnnaMaria Iorio5, Stefania Paolillo20, Pasquale Perrone Filardi21, Paola Gargiulo20, Maurizio Bussotti22, Giovanni Marchese22, Michele Correale23, Roberto Badagliacca24, Susanna Sciomer24, Pietro Palermo5, Mauro Contini5, Pantaleo Giannuzzi3, Elisa Battaia25, Mariantonietta Cicoira25, Francesco Clemenza26, Chiara Minà26, Simone Binno27, Claudio Passino8, Massimo F Piepoli27. 1. Centro Cardiologico Monzino, IRCCS, Milano, Italy; Unità Operativa Cardiologia Riabilitativa, Ospedale S. Giuseppe, Multimedica Spa, IRCCS, Milano, Italy; Scuola Superiore S. Anna, Pisa, Italy. 2. 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. 3. Divisione di Cardiologia Riabilitativa, Fondazione Salvatore Maugeri, Istituto Scientifico di Veruno, IRCCS, Veruno, Italy. 4. Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. 5. Centro Cardiologico Monzino, IRCCS, Milano, Italy. 6. Division of Cardiology, "S. Maugeri" Foundation, Institute of Cassano Murge, IRCCS, Bari, Italy. 7. UOC Cardiologia Ospedale S. Spirito, Roma Lungotevere in Sassia 3, Roma, Italy. 8. Fondazione Gabriele Monasterio, CNR-Regione Toscana, Pisa, Italy; Life Science Institute, Scuola Superiore Sant'Anna, Pisa, Italy. 9. Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy. 10. Centro Cardiovascolare, Azienda per i Servizi Sanitari n°1, Trieste, Italy. 11. Cardiologia SUN, Ospedale Monaldi (Azienda dei Colli), Seconda Università di Napoli, Napoli, Italy. 12. Fondazione Salvatore Maugeri, Istituto Scientifico di Tradate, Dipartimento di Medicina e Riabilitazione Cardiorespiratoria Unità Operativa di Cardiologia Riabilitativa, IRCCS, Tradate, Italy. 13. Cardiology Division, Cardiac Arrhythmia Center and Cardiomyopathies Unit, San Camillo-Forlanini Hospital, Roma, Italy. 14. Department of Medical Sciences, Cardiology, I.R.C.C.S. San Donato Hospital, University of Milan, San Donato Milanese, Milano, Italy. 15. Cardiologia Riabilitativa, Azienda Ospedali Riuniti, Ancona, Italy. 16. Dept of Clinical Medicine and Prevention, University of Milano Bicocca & Dept of Cardiology, S. Luca Hospital, Istituto Auxologico Italiano, Milano, Italy. 17. Dipartimento di Medicina Clinica e Molecolare, "Sapienza" Università degli Studi di Roma, Roma, Italy. 18. Dipartimento Cardiologico "A. De Gasperis", Ospedale Cà Granda- A.O. Niguarda, Milano, Italy. 19. Unità Operativa Cardiologia Riabilitativa, Ospedale S. Giuseppe, Multimedica Spa, IRCCS, Milano, Italy. 20. IRCCS SDN Istituto di Ricerca, Napoli, Italy. 21. Dipartimento di Scienze Biomediche Avanzate, Università Federico II Napoli, Italy. 22. Cardiac Rehabilitation Unit, Fondazione Salvatore Maugeri, Scientific Institute of Milan, IRCCS, Milan, Italy. 23. Department of Cardiology, University of Foggia, Foggia, Italy. 24. Dipartimento di Scienze Cardiovascolari, Respiratorie, Nefrologiche, Anestesioloigiche e Geriatriche, "Sapienza", Rome University, Rome, Italy. 25. Department of Medicine, Section of Cardiology, University of Verona, Verona, Italy. 26. Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation IRCCS-ISMETT, Palermo, Italy. 27. UOC Cardiologia, G da Saliceto Hospital, Piacenza, Italy.
Abstract
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/VCO2 slope), 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/VCO2 slope 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. PeakVO2 and LVEF, but not VE/VCO2 slope, 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.
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 HFpatients 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/VCO2 slope), 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/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb. CONCLUSIONS:Anemic HFpatients have a worse prognosis, but CPET can be safely performed. PeakVO2 and LVEF, but not VE/VCO2 slope, 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.
Authors: Justin M Canada; Tae Shik Park; Krishna Ravindra; Juan G Chiabrando; Marco Giuseppe Del Buono; Jessie van Wezenbeek; Cory R Trankle; Dinesh Kadariya; Larry Keen; Salvatore Carbone; Hayley Billingsley; George F Wohlford; Ross Arena; Benjamin W Van Tassell; Antonio Abbate Journal: J Cardiopulm Rehabil Prev Date: 2022-01-01 Impact factor: 2.081