Anemia and its association with clinical outcome in heart failure patients undergoing cardiac resynchronization
Ramkumar V Venkateswaran1, Carolyn Freeman2, Neal Chatterjee2
1Harvard Medical School, Boston, MA, USA.
Insights
Anemia in cardiac resynchronization therapy (CRT) patients is linked to worse outcomes. Both baseline anemia and a drop in hemoglobin after CRT implantation predict poorer 2-year survival.
Area of Science:
- Cardiology
- Hematology
- Medical Research
Background:
- Anemia is common in heart failure (HF) patients.
- Limited data exists on anemia's impact in cardiac resynchronization therapy (CRT) recipients.
- Investigating anemia's role in CRT outcomes is crucial for patient management.
Purpose of the Study:
- To assess if baseline hemoglobin (Hb) levels predict 2-year clinical outcomes in CRT patients.
- To determine if changes in Hb over time impact CRT patient prognosis.
- To evaluate the association between anemia and echocardiographic response to CRT.
Main Methods:
- Study included 300 CRT patients with available baseline and follow-up Hb.
- Anemia defined as Hb <12 g/dL (women) or <13 g/dL (men).
- Two-year outcomes included HF hospitalization, LVAD, transplant, and mortality; echocardiography assessed reverse remodeling.
Main Results:
- Baseline anemia was an independent predictor of worse 2-year outcomes (HR 1.79).
- Patients with the largest Hb decrease (≤-1.00 g/dL) had significantly poorer event-free survival (HR 1.84).
- Left ventricular reverse remodeling was similar between anemic and non-anemic groups.
Conclusions:
- Anemia at baseline and a post-CRT Hb decline are associated with worse 2-year prognosis.
- These factors predict outcomes independently of echocardiographic response.
- Managing anemia in CRT patients may improve clinical outcomes.
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.
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