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Herzinsuffizienz und Anämie

Heart failure and anemia

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Zusammenfassung

Die chronische Herzinsuffizienz gehört mit einer Prävalenz von 2% zu den häufigsten Erkrankungen in westlichen Ländern. Bei mehr als der Hälfte der Patienten liegt zusätzlich eine verminderte Hämoglobinkonzentration nach Kriterien der Weltgesundheitsorganisation (WHO) vor. Betroffen sind insbesondere niereninsuffiziente und ältere Patienten sowie Frauen. Verschiedene Pathomechanismen können bei einer Herzinsuffizienz zu einer Anämie führen. Eine eindeutige ätiologische Einordnung der Anämie ist nur bei einer Minderheit der Patienten möglich. Eine Anämie geht mit einem schlechteren klinischen Status und einem höheren Risiko für eine deshalb erforderliche Krankenhausbehandlung einher und wurde als Prädiktor für eine erhöhte Mortalität identifiziert. Die intravenöse Korrektur eines Eisendefizits führt bei systolischer Herzinsuffizienz zu einer Verbesserung der Leistungsfähigkeit und wird bei Patienten mit persistierenden Symptomen unter optimaler Herzinsuffizienztherapie empfohlen. Der klinische Nutzen von Stimulanzien der Erythropoietinproduktion konnte in randomisierten Studien nicht bestätig werden. Eine Anämie entsprechend WHO-Kriterien ist bei Patienten mit Herzinsuffizienz, aber erhaltener systolischer Pumpfunktion gleichfalls prognostisch ungünstig. Spezifische Therapieempfehlungen liegen für diese Patientengruppe bisher nicht vor.

Abstract

Chronic heart failure has an age-dependent prevalence of 2% and is therefore one of the most frequent diseases in western societies. A reduced hemoglobin concentration according to the definition of the World Health Organization is a common comorbidity affecting more than half of all heart failure patients. Elderly patients, patients suffering from renal impairment and women are more likely to develop anemia but a definitive etiology of anemia is only identified in the minority of cases. Anemia is associated with a poor clinical status and a greater risk of hospitalization and is a predictive factor for increased mortality. The incidence of anemia appears to increase with a poorer functional class. Intravenous iron therapy improves the exercise capacity in patients with systolic heart failure and iron deficiency and is currently being recommended for patients with persistent symptoms despite optimal medical and device therapy. However, erythropoietin-stimulating agents as a treatment for anemia in chronic heart failure have failed to improve clinical outcome in a large randomized trial. In patients with heart failure but with maintained ejection fraction, anemia is also associated with a poor prognosis. Specific therapeutic recommendations for these patients are still not available.

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Einhaltung der ethischen Richtlinien

Interessenkonflikt. S. Reda, L.J. Motloch und U.C. Hoppe geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik II für Innere Medizin, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, A-5020, Salzburg, Österreich

    S. Reda, L.J. Motloch & U.C. Hoppe

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  1. S. Reda
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  2. L.J. Motloch
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  3. U.C. Hoppe
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Correspondence to S. Reda.

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Reda, S., Motloch, L. & Hoppe, U. Herzinsuffizienz und Anämie. Herz 38, 597–603 (2013). https://doi.org/10.1007/s00059-013-3901-4

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