Felker G Michael, Shaw Linda K, Stough Wendy Gattis, O'Connor Christopher M
Duke Clinical Research Institute, Durham, NC 27705, USA.
Am Heart J. 2006 Feb;151(2):457-62. doi: 10.1016/j.ahj.2005.03.056.
Anemia has been shown to be a predictor of mortality in patients with heart failure and impaired left ventricular systolic function (ISF). Although heart failure in the setting of preserved systolic function (PSF) is an important clinical problem, the relationship between anemia and outcomes in patients with PSF has not been carefully evaluated.
Patients undergoing diagnostic angiography from 1995 to 2003 with symptomatic heart failure (New York Heart Association class II or greater) were studied (N = 4951). Patients with primary valvular or congenital heart disease were excluded. Patients with ejection fraction < or = 0.40 (N = 1858) were considered the ISF group, and patients with ejection fraction > 0.40 (N = 3093) were classified as the PSF group. Anemia was defined by the World Health Organization criteria (hemoglobin < 13 g/dL for men and < 12 g/dL for women). Multivariable Cox proportional hazards models were used to adjust for baseline differences. The possibility of a differential effect of anemia by systolic function was tested using an interaction term in the multivariable model.
Anemia was independently associated with adverse outcomes across the study cohort (adjusted hazard ratio = 1.53, P < .0001). There was no interaction between anemia and systolic function (ISF vs PSF) in the multivariable model (P = .31 for interaction). The hazard ratio for anemia was 1.61 for PSF patients and 1.45 for ISF patients.
Anemia is an independent predictor of mortality in heart failure, regardless of whether patients have preserved or impaired systolic function. This is the first report of an association between anemia and increased mortality in patients with heart failure and PSF. Future investigations of therapies for anemia in heart failure should consider including patients with PSF.
贫血已被证明是心力衰竭和左心室收缩功能受损（ISF）患者死亡率的预测指标。虽然收缩功能保留（PSF）情况下的心力衰竭是一个重要的临床问题，但贫血与PSF患者预后之间的关系尚未得到仔细评估。
对1995年至2003年接受诊断性血管造影的有症状心力衰竭（纽约心脏协会II级或更高）患者进行研究（N = 4951）。排除原发性瓣膜性或先天性心脏病患者。射血分数≤0.40的患者（N = 1858）被视为ISF组，射血分数>0.40的患者（N = 3093）被分类为PSF组。贫血根据世界卫生组织标准定义（男性血红蛋白<13 g/dL，女性血红蛋白<12 g/dL）。使用多变量Cox比例风险模型调整基线差异。在多变量模型中使用交互项测试贫血对收缩功能的差异影响可能性。
在整个研究队列中，贫血与不良结局独立相关（调整后的风险比 = 1.53，P <.0001）。多变量模型中贫血与收缩功能（ISF与PSF）之间没有交互作用（交互作用P = 0.31）。PSF患者贫血的风险比为1.61，ISF患者为1.45。
贫血是心力衰竭患者死亡率的独立预测指标，无论患者的收缩功能是保留还是受损。这是关于贫血与心力衰竭和PSF患者死亡率增加之间关联的首次报告。未来对心力衰竭贫血治疗的研究应考虑纳入PSF患者。
