Heart failure and anemia

Effects on prognostic variables

Gaia Cattadori, Piergiuseppe Agostoni, Ugo Corrà, Gianfranco Sinagra, Fabrizio Veglia, Elisabetta Salvioni, Alice Bonomi, Rocco La Gioia, Angela Beatrice Scardovi, Alessandro Ferraironi, Michele Emdin, Marco Metra, Andrea Di Lenarda, Giuseppe Limongelli, Rosa Raimondo, Federica Re, Marco Guazzi, Romualdo Belardinelli, Gianfranco Parati, Sergio Caravita & 31 others Damiano Magrì, Carlo Lombardi, Maria Frigerio, Fabrizio Oliva, Davide Girola, Alessandro Mezzani, Stefania Farina, Massimo Mapelli, Domenico Scrutinio, Giuseppe Pacileo, Anna Apostolo, Annamaria Iorio, Stefania Paolillo, Pasquale Perrone Filardi, Paola Gargiulo, Maurizio Bussotti, Giovanni Marchese, Michele Correale, Roberto Badagliacca, Susanna Sciomer, Pietro Palermo, Mauro Contini, Pantaleo Giannuzzi, Elisa Battaia, Mariantonietta Cicoira, Francesco Clemenza, Chiara Minà, Simone Maurizio Binno, Claudio Passino, Massimo F. Piepoli, MECKI score Research Group (appendix)

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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 (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively.

RESULTS: Median follow-up was 1363days (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, peakVO2 (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. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb<11g/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.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalEuropean Journal of Internal Medicine
Volume37
DOIs
Publication statusPublished - Jan 2017

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Anemia
Hemoglobins
Heart Failure
Exercise Test
Oxygen Consumption
Sodium

Keywords

  • Journal Article

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Heart failure and anemia : Effects on prognostic variables. / Cattadori, Gaia; Agostoni, Piergiuseppe; Corrà, Ugo; Sinagra, Gianfranco; Veglia, Fabrizio; Salvioni, Elisabetta; Bonomi, Alice; La Gioia, Rocco; Scardovi, Angela Beatrice; Ferraironi, Alessandro; Emdin, Michele; Metra, Marco; Lenarda, Andrea Di; Limongelli, Giuseppe; Raimondo, Rosa; Re, Federica; Guazzi, Marco; Belardinelli, Romualdo; Parati, Gianfranco; Caravita, Sergio; Magrì, Damiano; Lombardi, Carlo; Frigerio, Maria; Oliva, Fabrizio; Girola, Davide; Mezzani, Alessandro; Farina, Stefania; Mapelli, Massimo; Scrutinio, Domenico; Pacileo, Giuseppe; Apostolo, Anna; Iorio, Annamaria; Paolillo, Stefania; Filardi, Pasquale Perrone; Gargiulo, Paola; Bussotti, Maurizio; Marchese, Giovanni; Correale, Michele; Badagliacca, Roberto; Sciomer, Susanna; Palermo, Pietro; Contini, Mauro; Giannuzzi, Pantaleo; Battaia, Elisa; Cicoira, Mariantonietta; Clemenza, Francesco; Minà, Chiara; Binno, Simone Maurizio; Passino, Claudio; Piepoli, Massimo F.; MECKI score Research Group (appendix).

In: European Journal of Internal Medicine, Vol. 37, 01.2017, p. 56-63.

Research output: Contribution to journalArticle

Cattadori, G, Agostoni, P, Corrà, U, Sinagra, G, Veglia, F, Salvioni, E, Bonomi, A, La Gioia, R, Scardovi, AB, Ferraironi, A, Emdin, M, Metra, M, Lenarda, AD, Limongelli, G, Raimondo, R, Re, F, Guazzi, M, Belardinelli, R, Parati, G, Caravita, S, Magrì, D, Lombardi, C, Frigerio, M, Oliva, F, Girola, D, Mezzani, A, Farina, S, Mapelli, M, Scrutinio, D, Pacileo, G, Apostolo, A, Iorio, A, Paolillo, S, Filardi, PP, Gargiulo, P, Bussotti, M, Marchese, G, Correale, M, Badagliacca, R, Sciomer, S, Palermo, P, Contini, M, Giannuzzi, P, Battaia, E, Cicoira, M, Clemenza, F, Minà, C, Binno, SM, Passino, C, Piepoli, MF & MECKI score Research Group (appendix) 2017, 'Heart failure and anemia: Effects on prognostic variables', European Journal of Internal Medicine, vol. 37, pp. 56-63. https://doi.org/10.1016/j.ejim.2016.09.011
Cattadori, Gaia ; Agostoni, Piergiuseppe ; Corrà, Ugo ; Sinagra, Gianfranco ; Veglia, Fabrizio ; Salvioni, Elisabetta ; Bonomi, Alice ; La Gioia, Rocco ; Scardovi, Angela Beatrice ; Ferraironi, Alessandro ; Emdin, Michele ; Metra, Marco ; Lenarda, Andrea Di ; Limongelli, Giuseppe ; Raimondo, Rosa ; Re, Federica ; Guazzi, Marco ; Belardinelli, Romualdo ; Parati, Gianfranco ; Caravita, Sergio ; Magrì, Damiano ; Lombardi, Carlo ; Frigerio, Maria ; Oliva, Fabrizio ; Girola, Davide ; Mezzani, Alessandro ; Farina, Stefania ; Mapelli, Massimo ; Scrutinio, Domenico ; Pacileo, Giuseppe ; Apostolo, Anna ; Iorio, Annamaria ; Paolillo, Stefania ; Filardi, Pasquale Perrone ; Gargiulo, Paola ; Bussotti, Maurizio ; Marchese, Giovanni ; Correale, Michele ; Badagliacca, Roberto ; Sciomer, Susanna ; Palermo, Pietro ; Contini, Mauro ; Giannuzzi, Pantaleo ; Battaia, Elisa ; Cicoira, Mariantonietta ; Clemenza, Francesco ; Minà, Chiara ; Binno, Simone Maurizio ; Passino, Claudio ; Piepoli, Massimo F. ; MECKI score Research Group (appendix). / Heart failure and anemia : Effects on prognostic variables. In: European Journal of Internal Medicine. 2017 ; Vol. 37. pp. 56-63.
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abstract = "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 (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively.RESULTS: Median follow-up was 1363days (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, peakVO2 (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. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb<11g/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.",
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author = "Gaia Cattadori and Piergiuseppe Agostoni and Ugo Corr{\`a} and Gianfranco Sinagra and Fabrizio Veglia and Elisabetta Salvioni and Alice Bonomi and {La Gioia}, Rocco and Scardovi, {Angela Beatrice} and Alessandro Ferraironi and Michele Emdin and Marco Metra and Lenarda, {Andrea Di} and Giuseppe Limongelli and Rosa Raimondo and Federica Re and Marco Guazzi and Romualdo Belardinelli and Gianfranco Parati and Sergio Caravita and Damiano Magr{\`i} and Carlo Lombardi and Maria Frigerio and Fabrizio Oliva and Davide Girola and Alessandro Mezzani and Stefania Farina and Massimo Mapelli and Domenico Scrutinio and Giuseppe Pacileo and Anna Apostolo and Annamaria Iorio and Stefania Paolillo and Filardi, {Pasquale Perrone} and Paola Gargiulo and Maurizio Bussotti and Giovanni Marchese and Michele Correale and Roberto Badagliacca and Susanna Sciomer and Pietro Palermo and Mauro Contini and Pantaleo Giannuzzi and Elisa Battaia and Mariantonietta Cicoira and Francesco Clemenza and Chiara Min{\`a} and Binno, {Simone Maurizio} and Claudio Passino and Piepoli, {Massimo F.} and {MECKI score Research Group (appendix)}",
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TY - JOUR

T1 - Heart failure and anemia

T2 - Effects on prognostic variables

AU - Cattadori, Gaia

AU - Agostoni, Piergiuseppe

AU - Corrà, Ugo

AU - Sinagra, Gianfranco

AU - Veglia, Fabrizio

AU - Salvioni, Elisabetta

AU - Bonomi, Alice

AU - La Gioia, Rocco

AU - Scardovi, Angela Beatrice

AU - Ferraironi, Alessandro

AU - Emdin, Michele

AU - Metra, Marco

AU - Lenarda, Andrea Di

AU - Limongelli, Giuseppe

AU - Raimondo, Rosa

AU - Re, Federica

AU - Guazzi, Marco

AU - Belardinelli, Romualdo

AU - Parati, Gianfranco

AU - Caravita, Sergio

AU - Magrì, Damiano

AU - Lombardi, Carlo

AU - Frigerio, Maria

AU - Oliva, Fabrizio

AU - Girola, Davide

AU - Mezzani, Alessandro

AU - Farina, Stefania

AU - Mapelli, Massimo

AU - Scrutinio, Domenico

AU - Pacileo, Giuseppe

AU - Apostolo, Anna

AU - Iorio, Annamaria

AU - Paolillo, Stefania

AU - Filardi, Pasquale Perrone

AU - Gargiulo, Paola

AU - Bussotti, Maurizio

AU - Marchese, Giovanni

AU - Correale, Michele

AU - Badagliacca, Roberto

AU - Sciomer, Susanna

AU - Palermo, Pietro

AU - Contini, Mauro

AU - Giannuzzi, Pantaleo

AU - Battaia, Elisa

AU - Cicoira, Mariantonietta

AU - Clemenza, Francesco

AU - Minà, Chiara

AU - Binno, Simone Maurizio

AU - Passino, Claudio

AU - Piepoli, Massimo F.

AU - MECKI score Research Group (appendix)

N1 - Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.

PY - 2017/1

Y1 - 2017/1

N2 - 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 (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively.RESULTS: Median follow-up was 1363days (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, peakVO2 (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. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb<11g/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.

AB - 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 (<11g/dL), low (11-12 for females, 11-13 for males), normal (12-15 for females, 13-15 for males) and high (>15) Hb, respectively.RESULTS: Median follow-up was 1363days (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, peakVO2 (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. PeakVO2 and LVEF, but not VE/VCO2 slope, maintain their prognostic power also in HF patients with Hb<11g/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.

KW - Journal Article

U2 - 10.1016/j.ejim.2016.09.011

DO - 10.1016/j.ejim.2016.09.011

M3 - Article

VL - 37

SP - 56

EP - 63

JO - European Journal of Internal Medicine

JF - European Journal of Internal Medicine

SN - 0953-6205

ER -