Hemoglobin level threshold for cardiac remodeling and quality of life in myelodysplastic syndrome.

Treatment of myelodysplastic syndrome (MDS) with epoietin is costly. However, cardiac morbidity associated with anemia has not been investigated in MDS. We studied this aspect in 39 patients. Echocardiography detected cardiac remodeling in 11 of 12 transfusion-dependent versus 13 of 27 transfusion-free patients (P=0.017). Hemoglobin independently indicated cardiac hypertrophy (P=0.004); each unit increase predicted a 49% reduction in the risk of remodeling confirmed by the area under the ROC curve (0.84, P<0.0001). At Hb 10.7 g/dL, sensitivity was 96% and specificity 64%. Below this level quality of life was poorer. Our results suggest early treatment, to be confirmed by future trials.