Heart failure and anemia: Effects on prognostic variables
Heart failure and anemia: Effects on prognostic variables
复制标题
DOI：
10.1016/j.ejim.2016.09.011
复制
发表时间：
2017-01-01
影响因子：
8
通讯作者：
Piepoli, Massimo F.
中科院分区：
文献类型：
--
作者：
Cattadori, Gaia;Agostoni, Piergiuseppe;Piepoli, Massimo F.
背景：贫血在心力衰竭（HF）中很常见，并且与较高的死亡率相关。贫血HF patients.Methods：临床，实验室，超声心动图和心肺运动试验（CPET）的数据进行了分析，在3913 HF患者根据血红蛋白（Hb）值分组的预测能力建立HF预后参数是未知的。248例（6%）、857例（22%）、2160例（55%）和648例（17%）患者的Hb极低（15）。CPOA始终安全进行。Hb与预后相关（HR = 0.864）。正常组和高Hb组之间的预后无差异。在整个人群中，峰值氧耗量（VO 2）、呼吸效率（VE/VCO 2斜率）、血浆钠浓度、射血分数（LVEF）、肾功能和Hb与预后独立相关。分别考虑Hb组，峰值VO（2）（极低Hb HR = 0.549，低Hb HR = 0.613，正常Hb HR = 0.618，高Hb HR = 0.542）和LVEF（极低Hb HR = 0.49，低Hb HR = 0.692，正常Hb HR = 0.697，高Hb HR = 0.694）保持其预后作用。高VE/VCO 2斜率仅与低Hb和正常Hb患者的预后不良相关。结论：贫血性HF患者预后不良，但可以安全地进行CPET。在Hb < 11 g/dL的HF患者中，PeakVO（2）和LVEF（而不是VE/VCO 2斜率）也保持了其预后能力，这表明CPET的使用和低Hb HF患者的多参数方法。然而，以贫血为导向的随访对预后的影响尚不清楚。(C)2016年欧洲内科联盟。Elsevier B. V.出版，保留所有权利。
Background: Anemia is frequent in heart failure (HF), and it is associated with higher mortality. The predictive power of established HF prognostic parameters in anemic HF patients is unknown.Methods: Clinical, laboratory, echocardiographic and cardiopulmonary-exercise-test (CPET) data were analyzed in 3913 HF patients grouped according to hemoglobin (Hb) values. 248 (6%), 857 (22%), 2160 (55%) and 648 (17%) patients had very low (15) Hb, respectively.Results: Median follow-up was 1363 days (606-1883). CPETs were always performed safely. Hb was related to prognosis (Hazard ratio (HR) = 0.864). No prognostic difference was observed between normal and high Hb groups. Peak oxygen consumption (VO2), ventilatory efficiency (VE/VCO2 slope), plasma sodium concentration, ejection fraction (LVEF), kidney function and Hb were independently related to prognosis in the entire population. Considering Hb groups separately, peakVO(2) (very low Hb HR = 0.549, low Hb HR = 0.613, normal Hb HR = 0.618, high Hb HR = 0.542) and LVEF (very low Hb HR = 0.49, low Hb HR = 0.692, normal Hb HR = 0.697, high Hb HR = 0.694) maintained their prognostic roles. High VE/VCO2 slope was associated with poor prognosis only in patients with low and normal Hb.Conclusions: Anemic HF patients have a worse prognosis, but CPET can be safely performed. PeakVO(2) and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb < 11 g/dL, suggesting CPET use and a multiparametric approach in HF patients with low Hb. However, the prognostic effect of an anemia-oriented follow-up is unknown. (C) 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.