Santilli Giovanna, Tarantini Luigi, Baio Pierangelo, Senni Michele
U.S.C. di Medicina Cardiovascolare, Ospedali Riuniti, Bergamo.
G Ital Cardiol (Rome). 2011 May;12(5):319-26. doi: 10.1714/643.7496.
Anemia is a common comorbidity in patients with acute and chronic heart failure (HF) with preserved and reduced systolic function. It is recognized as a new therapeutic goal in HF since the reduction in hemoglobin levels is considered a significant independent predictive factor of mortality and hospitalization. At present, it is difficult to determine the real magnitude of the problem in terms of actual incidence and prevalence as no consistent definition of anemia associated with HF does exist, and a variety of hemoglobin thresholds have been used in clinical trials and epidemiological studies. The etiology of anemia is multifactorial with the main causes including renal failure, gastrointestinal bleeding and nutritional deficiency. Nevertheless, such criteria are not present in some patients, who show a peculiar type of anemia that may be classified as anemia of chronic diseases, likely due to the chronic inflammatory process of HF. No guidelines for the treatment of anemia in HF patients are available. Most of the previous studies in the literature are limited by small sample sizes. The very few randomized multicenter studies that evaluated the effects of erythropoiesis-stimulating agents associated with intravenous iron therapy did not provide the expected results. Indeed, despite an increase in hemoglobin levels, they did not show any improvement of NYHA functional class, nor of left ventricular ejection fraction. In addition, reasonable hemoglobin levels as a goal of therapy have not been established yet, in particular in relation to the side effects and the cardiovascular risk observed after the administration of erythropoiesis-stimulating agents in oncologic patients. Further studies are warranted to define the magnitude of the problem and establish appropriate therapeutic strategies. It is likely that more reliable data will be derived from an ongoing randomized, double-blind, multicenter study, the RED-HF (Reduction Event with Darbepoetin alfa in Heart Failure), which aims at evaluating morbidity and mortality in a cohort of 2600 HF patients with anemia treated with darbepoetin alfa.
贫血是急性和慢性心力衰竭（HF）患者中常见的合并症，无论收缩功能是保留还是降低。由于血红蛋白水平降低被认为是死亡率和住院率的重要独立预测因素，贫血已被视为心力衰竭的一个新的治疗目标。目前，由于不存在与心力衰竭相关贫血的一致定义，且临床试验和流行病学研究中使用了多种血红蛋白阈值，因此难以从实际发病率和患病率方面确定该问题的实际严重程度。贫血的病因是多因素的，主要原因包括肾衰竭、胃肠道出血和营养缺乏。然而，一些患者不存在这些标准，他们表现出一种特殊类型的贫血，可能归类为慢性病贫血，这可能是由于心力衰竭的慢性炎症过程所致。目前尚无针对心力衰竭患者贫血治疗的指南。文献中以前的大多数研究都受到样本量小的限制。极少数评估促红细胞生成剂联合静脉铁剂治疗效果的随机多中心研究并未取得预期结果。事实上，尽管血红蛋白水平有所升高，但他们并未显示纽约心脏协会（NYHA）功能分级或左心室射血分数有任何改善。此外，尚未确定合理的血红蛋白水平作为治疗目标，特别是考虑到在肿瘤患者中使用促红细胞生成剂后观察到的副作用和心血管风险。有必要进行进一步研究以确定该问题的严重程度并制定适当的治疗策略。正在进行的一项随机、双盲、多中心研究RED-HF（达贝泊汀α降低心力衰竭事件）可能会得出更可靠的数据，该研究旨在评估2600例接受达贝泊汀α治疗的贫血心力衰竭患者队列中的发病率和死亡率。
