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Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction.

Publication ,  Journal Article
Burns, JA; Sanchez, C; Beussink, L; Daruwalla, V; Freed, BH; Selvaraj, S; Shah, SJ
Published in: Am J Cardiol
October 15, 2018

Anemia is associated with a poor prognosis in heart failure with preserved ejection fraction (HFpEF), but the reasons underlying this association are unclear. Previous studies have reported an association between anemia and diastolic dysfunction. However, these studies used volume- and flow-dependent indexes of diastolic dysfunction. We hypothesized that in HFpEF, anemia is more closely associated with volume status and not markers of intrinsic myocardial dysfunction. We prospectively studied 419 outpatients in a systematic HFpEF program, all of whom underwent hemoglobin measurement and comprehensive echocardiography. Longitudinal, radial, and circumferential strain were also measured in 311 patients. We defined anemia as hemoglobin <12g/dL in women and <13g/dL in men. Linear and Cox regression analyses were used to determine the association between anemia and echocardiographic/strain variables and adverse outcomes, respectively. Over half (224/419 [53%]) of the HFpEF patients had anemia. Anemia was associated with volume (preload)-dependent markers of diastolic dysfunction including echocardiographic E/A (p = 0.004) and E/e' ratio (p = 0.014) and elevated right heart pressures such as right atrial pressure (p = 0.002) and pulmonary artery systolic pressure (p<0.001). Anemia was not associated with markers of intrinsic myocardial dysfunction such as lateral e' (p = 0.16) and septal e' (p = 0.65) velocities or echocardiographic strain parameters (p > 0.05 for all comparisons). Anemia was associated with the combined outcome of cardiovascular hospitalization or death (hazard ratio = 1.50 [95% confidence interval 1.20, 1.88]; p < 0.001). In conclusion, anemia in HFpEF is associated with markers of volume status and not intrinsic markers of myocardial dysfunction.

Duke Scholars

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

October 15, 2018

Volume

122

Issue

8

Start / End Page

1359 / 1365

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Prospective Studies
  • Middle Aged
  • Humans
  • Hemoglobins
  • Heart Failure
  • Echocardiography
  • Diastole
  • Cardiovascular System & Hematology
 

Citation

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Burns, J. A., Sanchez, C., Beussink, L., Daruwalla, V., Freed, B. H., Selvaraj, S., & Shah, S. J. (2018). Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction. Am J Cardiol, 122(8), 1359–1365. https://doi.org/10.1016/j.amjcard.2018.06.045
Burns, Jacob A., Cynthia Sanchez, Lauren Beussink, Vistasp Daruwalla, Benjamin H. Freed, Senthil Selvaraj, and Sanjiv J. Shah. “Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction.Am J Cardiol 122, no. 8 (October 15, 2018): 1359–65. https://doi.org/10.1016/j.amjcard.2018.06.045.
Burns JA, Sanchez C, Beussink L, Daruwalla V, Freed BH, Selvaraj S, et al. Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction. Am J Cardiol. 2018 Oct 15;122(8):1359–65.
Burns, Jacob A., et al. “Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction.Am J Cardiol, vol. 122, no. 8, Oct. 2018, pp. 1359–65. Pubmed, doi:10.1016/j.amjcard.2018.06.045.
Burns JA, Sanchez C, Beussink L, Daruwalla V, Freed BH, Selvaraj S, Shah SJ. Lack of Association Between Anemia and Intrinsic Left Ventricular Diastolic Function or Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction. Am J Cardiol. 2018 Oct 15;122(8):1359–1365.
Journal cover image

Published In

Am J Cardiol

DOI

EISSN

1879-1913

Publication Date

October 15, 2018

Volume

122

Issue

8

Start / End Page

1359 / 1365

Location

United States

Related Subject Headings

  • Ventricular Dysfunction, Left
  • Stroke Volume
  • Prospective Studies
  • Middle Aged
  • Humans
  • Hemoglobins
  • Heart Failure
  • Echocardiography
  • Diastole
  • Cardiovascular System & Hematology