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Int J Cardiol. 2016 Feb 15;205:6-12. doi: 10.1016/j.ijcard.2015.11.178. Epub 2015 Dec 2.

The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure.

Author information

  • 1Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
  • 2Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Poland.
  • 3Department of Cardiology, General Hospital Celje, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
  • 4Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
  • 5Center for Stroke Research Berlin, Charite University Medical School, Germany.
  • 6Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; 1st Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic.
  • 7Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany.
  • 8Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany. Electronic address: stephan.von.haehling@web.de.

Abstract

Anaemia and iron deficiency (ID) are important co-morbidities in patients with chronic heart failure (HF) and both may lead to reduced exercise capacity.

METHODS:

We enrolled 331 out-patients with stable chronic HF (mean age: 64 ± 11 years, 17% female, left ventricular ejection fraction [LVEF] 35 ± 13%, body mass index [BMI] 28.5 ± 5.2 kg/m(2), New York Heart Association [NYHA] class 2.2 ± 0.7, chronic kidney disease 35%, glomerular filtration rate 61.7 ± 20.1 mL/min). Anaemia was defined according to World Health Organization criteria (haemoglobin [Hb] < 13 g/dL in men, < 12 g/dL in women). ID was defined as serum ferritin < 100 μg/L or ferritin < 300 μg/L with transferrin saturation (TSAT) < 20%. Exercise capacity was assessed as peak oxygen consumption (peak VO2) by spiroergometry and 6-minute walk test (6MWT).

RESULTS:

A total of 91 (27%) patients died from any cause during a mean follow-up of 18 months. At baseline, 98 (30%) patients presented with anaemia and 149 (45%) patients presented with ID. We observed a significant reduction in exercise capacity in parallel to decreasing Hb levels (r = 0.24, p < 0.001). In patients with anaemia and ID (n = 63, 19%), exercise capacity was significantly lower than in patients with ID or anaemia only. Cox regression analysis showed that after adjusting for NYHA, age, hsCRP and creatinine anaemia is an independent predictor of mortality in patients with HF (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.33-0.97, p = 0.04).

CONCLUSION:

The impact of anaemia on reduced exercise capacity and on mortality is stronger than that of ID. Anaemia remained an independent predictor of death after adjusting for clinically relevant variables.

Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

KEYWORDS:

Anaemia; Exercise capacity; Heart failure; Iron deficiency

PMID:
26705670
[PubMed - in process]
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