Heart Failure with Anemia: Novel Findings on the Roles of Renal Disease, Interleukins, and Specific Left Ventricular Remodeling Processes
Background—Anemia is a highly prevalent and strong independent prognostic marker in heart failure (HF), yet this association is not completely understood. Whether anemia is simply a marker of disease severity and concomitant chronic kidney disease (CKD) or represents the activation of other detrimental pathways remains uncertain. We sought to determine which pathophysiological pathways are exacerbated in patients with HF, reduced ejection fraction (HF-REF) and anemia; in comparison to those without anemia.
Methods and Results—In a prospective study involving 151 patients, selected biomarkers were analyzed; each representing proposed contributive mechanisms in the pathophysiology of anemia in HF. We compared clinical, echocardiographic and circulating biomarkers profiles between patients with HF-REF and anemia (group 1); HF-REF without anemia (group 2); and CKD with preserved EF, without established HF (CKD control group 3). We demonstrate here that many processes other than those related to CKD are involved in the anemia-HF relationship. These are linked to the pathophysiological mechanisms pertaining to left ventricular systolic dysfunction and remodeling, systemic inflammation and volume overload. We found that levels of IL-6 and IL-10, specific markers of cardiac remodeling (PIIINP, MMP2, TIMP-1, left atrial volume), myocardial stretch (NT-proBNP) and myocyte death (TnT) are related to anemia in HF-REF.
Conclusions—Anemia is strongly associated with markers of more advanced and active heart disease, and not only with the level of renal dysfunction in HF-REF. Increased myocardial remodeling, inflammation and volume overload are the hallmarks of patients with anemia and HF.
Clinical Trial Registration—URL: http://www.clinicaltrials.gov. Unique identifier: NCT00834691.
- Received January 10, 2014.
- Accepted June 27, 2014.