Kourea Kallirrhoe, Parissis John T, Farmakis Dimitrios, Paraskevaidis Ioannis, Panou Fotios, Filippatos Gerasimos, Kremastinos Dimitrios Th
Second Department of Cardiology and Heart Failure Unit, University of Athens Medical School, Attikon University Hospital, Athens, Greece.
Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):365-9. doi: 10.1097/HJR.0b013e3282f849d0.
Anemia is a frequent comorbidity in chronic heart failure (CHF) adversely affecting patients' prognosis. Erythropoietin seems to improve exercise capacity in CHF patients. This study investigates the effects of recombinant human erythropoietin analog darbepoetin-alpha on quality of life and emotional stress, evaluated by relevant questionnaires in patients with CHF and anemia.
Forty-one CHF patients [New York Heart Association class: II-III; left ventricular (LV) ejection fraction (EF)<40%; hemoglobin<12.5 g/dl; serum creatinine<2.5 mg/dl] were randomized (1:1) to receive either 3-month darbepoietin-alpha at 1.5 microg/Kg every 20 days plus iron orally (n=21) or placebo plus iron orally (n=20). Echocardiographic LVEF, questionnaires addressing quality of life (Kansas City Cardiomyopathy Questionnaire, functional and overall, Duke's Activity Status Index) and emotional stress [Zung self-rating depression scale (SDS), Beck Depression Inventory], as well as plasma b-type natriuretic peptide and 6-min walking distance (6MWT as a marker of exercise capacity) were assessed at baseline and posttreatment.
A significant improvement in LVEF (32+/-6 from 26+/-6%, P<0.001), 6MWT (274+/-97 from 201+/-113 m, P<0.01), hemoglobin (12.8+/-1.4 from 10.9+/-1.0 g/dl, P<0.001) and plasma b-type natriuretic peptide (517+/-579 from 829+/-858 pg/ml, P=0.002) was observed posttreatment only in darbepoetin-treated group. Kansas City Cardiomyopathy Questionnaire functional (78+/-14 from 57+/-24%, P<0.01) and overall (68+/-20 from 47+/-22, P<0.001), Duke's Activity Status Index (19+/-11 from 14+/-9, P<0.05), Zung SDS (38+/-10 from 47+/-11, P<0.05) and Beck Depression Inventory (11+/-9 from 16+/-10, P<0.05) scores also improved in darbepoetin-treated patients, whereas they remain unchanged in the placebo group except for the Zung SDS which worsened (P<0.05). A significant correlation between drug-induced percent changes in 6MWT and Zung SDS (r=-0.627, P<0.05) was also observed.
Darbepoetin-alpha improves quality of life and emotional stress in CHF patients with anemia, with a parallel increase in exercise capacity.
贫血是慢性心力衰竭（CHF）常见的合并症，对患者预后产生不利影响。促红细胞生成素似乎可改善CHF患者的运动能力。本研究通过相关问卷调查，探讨重组人促红细胞生成素类似物达贝泊汀-α对CHF合并贫血患者生活质量和情绪应激的影响。
41例CHF患者[纽约心脏协会心功能分级：II-III级；左心室（LV）射血分数（EF）<40%；血红蛋白<12.5 g/dl；血清肌酐<2.5 mg/dl]被随机分为两组（1:1），一组每20天接受1.5 μg/Kg的达贝泊汀-α治疗3个月并口服铁剂（n=21），另一组接受安慰剂加口服铁剂（n=20）。在基线和治疗后评估超声心动图LVEF、生活质量问卷（堪萨斯城心肌病问卷，功能和总体部分、杜克活动状态指数）、情绪应激[zung自评抑郁量表（SDS）、贝克抑郁量表]，以及血浆b型利钠肽和6分钟步行距离（6MWT作为运动能力的指标）。
仅在接受达贝泊汀治疗的组中，治疗后观察到LVEF（从26±6%提高到32±6%，P<0.001）、6MWT（从201±113 m提高到274±97 m，P<0.01）、血红蛋白（从10.9±1.0 g/dl提高到12.8±1.4 g/dl，P<0.001）和血浆b型利钠肽（从829±858 pg/ml降低到517±579 pg/ml，P=0.002）有显著改善。接受达贝泊汀治疗的患者，堪萨斯城心肌病问卷功能部分（从57±24%提高到78±14%，P<0.01）和总体部分（从47±22提高到68±20，P<0.001）、杜克活动状态指数（从14±9提高到19±11，P<0.05）、zung SDS（从47±11降低到38±10，P<0.05）和贝克抑郁量表（从16±10降低到11±9，P<0.05）评分也有所改善，而在安慰剂组中，除zung SDS恶化（P<0.05）外，其余指标均无变化。还观察到药物引起的6MWT变化百分比与zung SDS之间存在显著相关性（r=-0.
