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Anemia is associated with an increased central venous pressure and mortality in a broad spectrum of cardiovascular patients

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Abstract

Background

Anemia is frequently observed in patients with cardiovascular disease. Multiple factors have been associated with anemia, but the role of hemodynamics is largely unknown. Therefore, we investigated the association between hemoglobin (Hb) levels, hemodynamics and outcome in a broad spectrum of cardiovascular patients.

Methods and results

A total of 2,009 patients who underwent right heart catheterization at the University Medical Center Groningen, the Netherlands, between 1989 and 2006 were identified and data were extracted from electronic databases. Anemia was defined by the WHO criteria (male, hemoglobin <13.0 g/dL; female, hemoglobin <12.0 g/dL). The associations between central venous pressure (CVP), cardiac index (CI), systemic vascular resistance (SVR), hemoglobin (Hb), anemia and all-cause mortality were assessed with linear, logistic and Cox-proportional hazards analysis. The mean age was 57 ± 15 years, 57 % were male, mean Hb was 13.2 ± 0.4 g/dL, and 27.4 % of the patients were anemic. Patients with anemia had higher CVP levels (7.0 ± 5.4 mmHg) compared to non-anemic patients (5.6 ± 4.1 mmHg; p < 0.001). CI was higher in anemic patients; 3.0 ± 2.9 vs. 2.9 ± 0.8 L/min/m2 (p < 0.001), whereas SVR was lower (1,212 ± 479 vs. 1,356 ± 555 dyn s cm−5, p < 0.001). CVP and CI were both independent predictors of anemia (OR 1.49; CI 1.24–1.81, p < 0.001 and OR 1.93; CI 1.54–2.42, p < 0.001, respectively). Hemoglobin and CVP were both independent predictors of survival. Independent of CI and renal function, patients with anemia and an elevated CVP had the worst prognosis (HR 2.17; 95 % CI 1.62–2.90; p < 0.001).

Conclusion

Anemia is common in cardiovascular patients and independently related to an elevated CVP and CI. Patients with anemia and an elevated CVP have the worst prognosis.

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Acknowledgments

Dr. Van der Meer and Westenbrink received personal research grants from the Dutch heart Foundation (Grant 2012T047 and 2012T066, respectively) Prof. Voors is a Clinical Established Investigator of the Dutch heart Foundation (2006T37).

Conflict of interest

Prof. Dr. Voors received consultancy fees and/or research grants from: Alere; Bayer; Cardio3Biosciences; Celladon; Novartis; Servier; Vifor Pharma. Prof. Voors is supported by a grant from the European Commission: FP7-242209-BIOSTAT-CHF. Dr. van der Meer received consulting fees from Vifor. Prof. Dr. D.J. Van Veldhuisen has received Boiard membership fees from Amgen and Vifor.

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Authors and Affiliations

  1. Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB, Groningen, The Netherlands

    Lennaert Kleijn, B. Daan Westenbrink, Vincent M. van Deursen, Kevin Damman, Rudolf A. de Boer, Hans L. Hillege, Dirk J. van Veldhuisen, Adriaan A. Voors & Peter van der Meer

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  1. Lennaert Kleijn
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  2. B. Daan Westenbrink
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  3. Vincent M. van Deursen
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  4. Kevin Damman
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  5. Rudolf A. de Boer
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  6. Hans L. Hillege
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  7. Dirk J. van Veldhuisen
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  8. Adriaan A. Voors
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  9. Peter van der Meer
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Correspondence to Peter van der Meer.

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Kleijn, L., Westenbrink, B.D., van Deursen, V.M. et al. Anemia is associated with an increased central venous pressure and mortality in a broad spectrum of cardiovascular patients. Clin Res Cardiol 103, 467–476 (2014). https://doi.org/10.1007/s00392-014-0673-7

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