Kosiborod Mikhail, Krumholz Harlan M, Jones Philip G, Pitt Bertram, Spertus John A
Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, Missouri, USA.
J Card Fail. 2008 Feb;14(1):27-34. doi: 10.1016/j.cardfail.2007.09.009.
Studies have identified anemia as a potential therapeutic target in patients with heart failure, with the goal of improving survival and health status. However, whether changes in hematocrit are associated with changes in health status is unknown.
We studied 1382 patients with heart failure after myocardial infarction who had serial hematocrits and health status assessments with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Linear regression models assessed the relationship between change in hematocrit and change in health status between 1 month (baseline) and 3 months after hospitalization. During follow-up, 12.6% of patients experienced a greater than 2% decline in hematocrit, 32.5% experienced a greater than 2% improvement in hematocrit, and 54.9% had no significant hematocrit change. After multivariable adjustment there was a highly significant interaction (P = .007) between baseline hematocrit and change in hematocrit, suggesting that the effects of changes in hematocrit on health status vary as a function of patients' initial hematocrits. Patients with severe anemia initially (hematocrit < or = 33%) experienced marked decrements in health status (-4.4 point KCCQ change per 1% hematocrit decline, P = .006) with further declines in hematocrit, but only modest health status gains with hematocrit improvements (0.6 point KCCQ change per 1% hematocrit improvement, P = .3). Less pronounced changes were observed among patients with a baseline hematocrit greater than 33% to 39%, and no significant changes were seen in patients with hematocrit levels greater than 39%.
Among anemic patients with heart failure, a decrease in hematocrit is associated with marked decline in health status, whereas health status gains associated with hematocrit improvements are modest.
研究已将贫血确定为心力衰竭患者的一个潜在治疗靶点，目标是提高生存率和健康状况。然而，血细胞比容的变化是否与健康状况的变化相关尚不清楚。
我们研究了1382例心肌梗死后心力衰竭患者，这些患者接受了连续的血细胞比容检测，并使用堪萨斯城心肌病问卷（KCCQ）进行健康状况评估。线性回归模型评估了住院后1个月（基线）至3个月期间血细胞比容变化与健康状况变化之间的关系。在随访期间，12.6%的患者血细胞比容下降超过2%，32.5%的患者血细胞比容改善超过2%，54.9%的患者血细胞比容无显著变化。多变量调整后，基线血细胞比容与血细胞比容变化之间存在高度显著的相互作用（P = 0.007），这表明血细胞比容变化对健康状况的影响因患者初始血细胞比容而异。最初患有严重贫血（血细胞比容≤33%）的患者，随着血细胞比容进一步下降，健康状况显著下降（血细胞比容每下降1%，KCCQ变化-4.4分，P = 0.006），但血细胞比容改善时健康状况仅适度改善（血细胞比容每改善1%，KCCQ变化0.6分，P = 0.3）。基线血细胞比容大于33%至39%的患者变化不太明显，血细胞比容水平大于39%的患者未观察到显著变化。
在贫血的心力衰竭患者中，血细胞比容降低与健康状况显著下降相关，而血细胞比容改善带来的健康状况改善则较为适度。
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