Prevalence, prognosis, and therapeutic implications of unrecognized left ventricular systolic dysfunction in patients

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Sabha Bhatti1, Abdul Hakeem, Kathryn S Dillie

  • 1Division of Cardiovascular Diseases, University of Cincinnati, College of Medicine, Cincinnati, OH, USA. bhattisa@ucmail.uc.edu

Congestive Heart Failure (Greenwich, Conn.)
|November 25, 2010
PubMed

Insights

Unrecognized left ventricular dysfunction (ULVSD) is more common in patients with both anemia and chronic kidney disease (CKD). This combination significantly increases the risk of death and heart failure hospitalization (HFH).

Area of Science:

  • Cardiology
  • Nephrology
  • Internal Medicine

Background:

  • The clinical implications of unrecognized left ventricular dysfunction (ULVSD) in patients with concurrent anemia and chronic kidney disease (CKD) remain largely uncharacterized.
  • Anemia and CKD are common comorbidities that may contribute to cardiac dysfunction, yet their specific role in ULVSD is not well-defined.

Purpose of the Study:

  • To investigate whether anemia and CKD are independent risk factors for developing ULVSD.
  • To assess the impact of ULVSD, particularly in the context of anemia and CKD, on major adverse cardiovascular outcomes, including all-cause mortality and heart failure hospitalization (HFH).

Main Methods:

  • A cohort of 1358 patients without a history of heart failure (HF), undergoing myocardial perfusion imaging for suspected coronary artery disease, were analyzed.
  • Patients were categorized into four groups based on the presence or absence of anemia (hemoglobin <13 g/L) and CKD (glomerular filtration rate <60 mL/min).
  • Gated myocardial perfusion single-photon emission computed tomography (SPECT) was used to assess left ventricular ejection fraction (LVEF) and identify ULVSD (LVEF <35%). Clinical outcomes, including death and HFH, were tracked over a mean follow-up of 2.15 years.

Main Results:

  • Patients with both anemia and CKD exhibited a significantly higher prevalence of ULVSD (11.3%) compared to those without either condition (4%; P=.0009).
  • The combined presence of anemia and CKD was associated with substantially increased rates of death (12% per year vs. 3.5% per year; P<.0001) and HFH (8% per year vs. 1.5% per year; P<.0001) compared to the control group.
  • Among patients with ULVSD, only 65% were receiving guideline-directed medical therapy, including angiotensin-converting enzyme inhibitors/angiotensin receptor blockers and beta-blockers.

Conclusions:

  • The co-occurrence of anemia and CKD significantly elevates the risk of ULVSD, nearly tripling its prevalence compared to patients without these conditions.
  • ULVSD in patients with anemia and CKD is linked to a markedly higher risk of mortality and HFH, underscoring the importance of early detection.
  • Screening for ULVSD in patients with anemia and CKD may be warranted, as timely therapeutic interventions could potentially improve clinical outcomes.

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