Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Division of Cardiology, County Hospital Ryhov, Jönköping, Sweden.
Int J Cardiol. 2020 Jan 1;298:59-65. doi: 10.1016/j.ijcard.2019.08.049. Epub 2019 Aug 28.
The role of anemia in heart failure with mid-range and preserved ejection fraction (HFmrEF, EF 40-49% and HFpEF, EF ≥50%) is unknown. We aimed to compare prevalence of, associations with, and prognostic role of anemia in HF across the EF spectrum.
In patients from the Swedish HF Registry, we assessed the associations between clinical characteristics and anemia (hemoglobin <120 g/L in women and <130 g/L in men) by multivariable logistic regression, and between anemia, composite of all-cause death and HF hospitalization and all-cause death alone by multivariable Cox regression.
Of 49,985 patients with HF (anemia = 34%), 23% had HFpEF (anemia = 41%), 21% had HFmrEF (anemia = 35%) and 55% had HFpEF (anemia = 32%). Higher EF was independently associated with higher likelihood of concomitant anemia. Important predictors of anemia across the EF spectrum were male sex, older age, worse New York Heart Association class and renal function, lower systolic blood pressure, higher N-Terminal B-type natriuretic peptides levels, diabetes, valvular disease and in-patient status. Anemia had adjusted hazard ratios (95% CI) for mortality or HF hospitalization 1.24 (1.18-1.30) in HFpEF, 1.26 (1.19-1.34) in HFmrEF and 1.14 (1.10-1.19) in HFrEF; pEF = 0.003; and for mortality 1.28 (1.20-1.36) in HFpEF, 1.21 (1.13-1.29) in HFmrEF, and 1.30 (1.24-1.35) in HFrEF; pEF = 0.22.
In this nation-wide registry, prevalence of anemia was higher in HFpEF vs. HFmrEF vs. HFrEF, but was associated with a similarly increased risk of death across the EF spectrum, with greater risk of death or HF hospitalization in HFpEF and HFmrEF vs. HFrEF.
贫血在射血分数中间范围和保留型心力衰竭（HFmrEF，EF 为 40-49%和 HFpEF，EF≥50%）中的作用尚不清楚。我们旨在比较 EF 谱中心力衰竭患者贫血的患病率、相关性和预后作用。
在瑞典心力衰竭登记处的患者中，我们通过多变量逻辑回归评估了临床特征与贫血（女性血红蛋白<120g/L 和男性血红蛋白<130g/L）之间的关系，并通过多变量 Cox 回归评估了贫血、全因死亡和心力衰竭住院的复合终点以及全因死亡与贫血之间的关系。
在 49985 例心力衰竭患者中（贫血患者占 34%），23%患有 HFpEF（贫血患者占 41%），21%患有 HFmrEF（贫血患者占 35%），55%患有 HFpEF（贫血患者占 32%）。较高的 EF 与同时发生贫血的可能性更高独立相关。EF 谱中贫血的重要预测因素包括男性、年龄较大、纽约心脏协会心功能分级较差和肾功能较差、较低的收缩压、较高的 N 末端 B 型利钠肽水平、糖尿病、瓣膜病和住院状态。贫血患者的全因死亡率或心力衰竭住院调整后的危险比（95%CI）在 HFpEF 中为 1.24（1.18-1.30），在 HFmrEF 中为 1.26（1.19-1.34），在 HFrEF 中为 1.14（1.10-1.19）；pEF=0.003；在 HFpEF 中，全因死亡率的危险比为 1.28（1.20-1.36），在 HFmrEF 中为 1.21（1.13-1.29），在 HFrEF 中为 1.30（1.24-1.35）；pEF=0.22。
在这项全国性登记研究中，HFpEF 中的贫血患病率高于 HFmrEF 高于 HFrEF，但与 EF 谱中死亡率的增加风险具有相似的相关性，HFpEF 和 HFmrEF 患者的死亡或心力衰竭住院风险高于 HFrEF。
