Skip to main content

Advertisement

SpringerLink
Log in

Anemia and its association with clinical outcome in heart failure patients undergoing cardiac resynchronization therapy

  • MULTIMEDIA REPORT
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Bristow, M. R., Saxon, L. A., Boehmer, J., Krueger, S., Kass, D. A., De Marco, T., et al. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. New England Journal of Medicine, 350(21), 2140–2150.

    Article  CAS  PubMed  Google Scholar 

  2. Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. New England Journal of Medicine, 352(15), 1539–1549.

    Article  CAS  PubMed  Google Scholar 

  3. Go, A. S., Mozaffarian, D., Roger, V. L., Benjamin, E. J., Berry, J. D., Blaha, M. J., et al. (2014). Heart disease and stroke statistics—2014 update: a report from the American heart association. Circulation, 129(3), e28–e292.

    Article  PubMed  Google Scholar 

  4. McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Bohm, M., Dickstein, K., et al. (2012). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the task force for the diagnosis and treatment of acute and chronic heart failure 2012 of the European society of cardiology. Developed in collaboration with the heart failure association (HFA) of the ESC. European Journal of Heart Failure, 14(8), 803–869.

    Article  CAS  PubMed  Google Scholar 

  5. Bilchick, K. C., Kamath, S., DiMarco, J. P., & Stukenborg, G. J. (2010). Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in medicare patients. Circulation, 122(20), 2022–2030.

    Article  PubMed Central  PubMed  Google Scholar 

  6. European Society of, C., European Heart Rhythm, A, Brignole, M., Auricchio, A., Baron-Esquivias, G., & Bordachar, P. (2013). 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European society of cardiology (ESC). Developed in collaboration with the European heart rhythm association (EHRA). Europace, 15(8), 1070–1118.

    Article  Google Scholar 

  7. Felker, G. M., Adams, K. F., Jr., Gattis, W. A., & O'Connor, C. M. (2004). Anemia as a risk factor and therapeutic target in heart failure. Journal of the American College of Cardiology, 44(5), 959–966.

    Article  PubMed  Google Scholar 

  8. Mitchell, J. E. (2007). Emerging role of anemia in heart failure. American Journal of Cardiology, 99(6B), 15D–20D.

    Article  PubMed  Google Scholar 

  9. Anand, I. S. (2008). Anemia and chronic heart failure implications and treatment options. Journal of the American College of Cardiology, 52(7), 501–511.

    Article  PubMed  Google Scholar 

  10. Komajda, M. (2004). Prevalence of anemia in patients with chronic heart failure and their clinical characteristics. Journal of Cardiac Failure, 10(1 Suppl), S1–4.

    Article  PubMed  Google Scholar 

  11. Tang, Y. D., & Katz, S. D. (2008). The prevalence of anemia in chronic heart failure and its impact on the clinical outcomes. Heart Failure Reviews, 13(4), 387–392.

    Article  PubMed  Google Scholar 

  12. Anand, I. S., Kuskowski, M. A., Rector, T. S., Florea, V. G., Glazer, R. D., Hester, A., et al. (2005). Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT. Circulation, 112(8), 1121–1127.

    Article  CAS  PubMed  Google Scholar 

  13. Horwich, T. B., Fonarow, G. C., Hamilton, M. A., MacLellan, W. R., & Borenstein, J. (2002). Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. Journal of the American College of Cardiology, 39(11), 1780–1786.

    Article  PubMed  Google Scholar 

  14. O'Meara, E., Clayton, T., McEntegart, M. B., McMurray, J. J., Lang, C. C., Roger, S. D., et al. (2006). Clinical correlates and consequences of anemia in a broad spectrum of patients with heart failure: results of the Candesartan in heart failure: assessment of reduction in mortality and morbidity (CHARM) program. Circulation, 113(7), 986–994.

    Article  PubMed  Google Scholar 

  15. European Heart Rhythm, A., European Society of, C., Heart Rhythm, S., Heart Failure Society of, A., American Society of, E., American Heart, A, et al. (2012). 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm, 9(9), 1524–1576.

    Article  Google Scholar 

  16. Weiss, G., & Goodnough, L. T. (2005). Anemia of chronic disease. New England Journal of Medicine, 352(10), 1011–1023.

    Article  CAS  PubMed  Google Scholar 

  17. Anand, I. S. (2010). Pathophysiology of anemia in heart failure. Heart Failure Clinics, 6(3), 279–288.

    Article  PubMed  Google Scholar 

  18. O'Meara, E., Rouleau, J. L., White, M., Roy, K., Blondeau, L., Ducharme, A., et al. (2014). Heart failure with anemia: novel findings on the roles of renal disease, interleukins, and specific left ventricular remodeling processes. Circulation. Heart Failure, 7(5), 773–781.

    Article  PubMed  Google Scholar 

  19. Anand, I., McMurray, J. J., Whitmore, J., Warren, M., Pham, A., McCamish, M. A., et al. (2004). Anemia and its relationship to clinical outcome in heart failure. Circulation, 110(2), 149–154.

    Article  PubMed  Google Scholar 

  20. Boerrigter, G., Costello-Boerrigter, L. C., Abraham, W. T., Sutton, M. G., Heublein, D. M., Kruger, K. M., et al. (2008). Cardiac resynchronization therapy improves renal function in human heart failure with reduced glomerular filtration rate. Journal of Cardiac Failure, 14(7), 539–546.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Palazzuoli, A., Ruocco, G., Pellegrini, M., De Gori, C., Del Castillo, G., Giordano, N., et al. (2014). The role of erythropoietin stimulating agents in anemic patients with heart failure: solved and unresolved questions. Therapeutics and Clinical Risk Management, 10, 641–650.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

    Authors and Affiliations

    1. Harvard Medical School, Boston, MA, USA

      Ramkumar V. Venkateswaran & G. William Dec

    2. Massachusetts General Hospital, Cardiology Division, Boston, MA, USA

      Carolyn Freeman, Neal Chatterjee, Jagdesh Kandala, Mary Orencole, Eszter M. Vegh, Kimberly A. Parks, G. William Dec, Jagmeet P. Singh & Rasmus Borgquist

    3. University Hospital Southampton NHS Foundation Trust, Southampton, UK

      Peter J. Cowburn

    4. Lund University, Arrhythmia Clinic, Skane University Hospital, Lund, Sweden

      Rasmus Borgquist

    Authors
    1. Ramkumar V. Venkateswaran
      View author publications

      You can also search for this author in PubMed Google Scholar

    2. Carolyn Freeman
      View author publications

      You can also search for this author in PubMed Google Scholar

    3. Neal Chatterjee
      View author publications

      You can also search for this author in PubMed Google Scholar

    4. Jagdesh Kandala
      View author publications

      You can also search for this author in PubMed Google Scholar

    5. Mary Orencole
      View author publications

      You can also search for this author in PubMed Google Scholar

    6. Eszter M. Vegh
      View author publications

      You can also search for this author in PubMed Google Scholar

    7. Kimberly A. Parks
      View author publications

      You can also search for this author in PubMed Google Scholar

    8. Peter J. Cowburn
      View author publications

      You can also search for this author in PubMed Google Scholar

    9. G. William Dec
      View author publications

      You can also search for this author in PubMed Google Scholar

    10. Jagmeet P. Singh
      View author publications

      You can also search for this author in PubMed Google Scholar

    11. Rasmus Borgquist
      View author publications

      You can also search for this author in PubMed Google Scholar

    Corresponding author

    Correspondence to Rasmus Borgquist.

    Ethics declarations

    Conflicts of interest

    Dr. Singh reports lectures, research grants, and consulting for Biotronik, Boston Scientific, St. Jude Medical, Medtronic and Sorin, as well as consulting for Respicardia and CardioInsight Inc. Dr. Parks reports consulting for Biotronic and honorary speaking for St. Jude Medical.

    All other authors report no relevant disclosures.

    Additional information

    Ramkumar V. Venkateswaran and Carolyn Freeman contributed equally to this work.

    Electronic supplementary material

    Below is the link to the electronic supplementary material.

    Supplementary Fig. 3

    Kaplan-Meier estimate of time to the primary composite endpoint within subgroups based on age and gender, stratified by pre-implant anemia. Kaplan-Meier curves show cumulative survival free from the composite endpoint of heart failure hospitalization, left ventricular assist device (LVAD), heart transplant or death. P value is for log-rank test comparison between the two groups. (GIF 397 kb)

    (TIFF 2247 kb)

    Supplementary Table 1

    (DOCX 31 kb)

    Rights and permissions

    Reprints and permissions

    About this article

    Check for updates. Verify currency and authenticity via CrossMark

    Cite this article

    Venkateswaran, R.V., Freeman, C., Chatterjee, N. et al. Anemia and its association with clinical outcome in heart failure patients undergoing cardiac resynchronization therapy. J Interv Card Electrophysiol 44, 297–304 (2015). https://doi.org/10.1007/s10840-015-0062-9

    Download citation

    • Received:

    • Accepted:

    • Published:

    • Issue Date:

    • DOI: https://doi.org/10.1007/s10840-015-0062-9

    Keywords

    Search

    Navigation