Anemia in Heart Failure Patients

Abstract

Heart failure is a very common disease, with severe morbidity and mortality, and a frequent reason of hospitalization. Anemia and a concurrent renal impairment are two major risk factors contributing to the severity of the outcome and consist of the cardio renal anemia syndrome. Anemia in heart failure is complex and multifactorial. Hemodilution, absolute or functional iron deficiency, activation of the inflammatory cascade, and impaired erythropoietin production and activity are some pathophysiological mechanisms involved in anemia of the heart failure. Furthermore other concomitant causes of anemia, such as myelodysplastic syndrome and chemotherapy, may worsen the outcome. Based on the pathophysiology of cardiac anemia, there are several therapeutic options that may improve hemoglobin levels, tissues' oxygenation, and probably the outcome. These include administration of iron, erythropoiesis-stimulating agents, and blood transfusions but still the evidence provided for their use remains limited.

Prognostic value of N‐terminal pro C‐type natriuretic peptide in heart failure patients with preserved and reduced ejection fraction

“…Levels of NT‐proBNP are strongly influenced by age, sex, and the presence of co‐morbidities such as obesity, AF, anaemia, pulmonary disease, hypertrophy, and renal insufficiency, which are often present in patients with HFpEF . In addition, levels of BNP and NT‐proBNP are often lower in patients with HFpEF compared with those with HFrEF . Heart failure with preserved ejection fraction has gained increasing interest over the past years.…”

“…23 In addition, levels of BNP and NT-proBNP are often lower in patients with HFpEF compared with those with HFrEF. 18,24,25 Heart failure with preserved ejection fraction has gained increasing interest over the past years. It accounts for up to half of all HF cases 24 and has a similar poor prognosis to HFrEF.…”

“…Monoclonal recombinant fragment antigen binding regions from immunized mice were used. Mice were immunized using peptide immunization for proCNP amino acid (amino acids [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], the primary antibody. The secondary antibody was generated from a peptide immunization of the proCNP region peptide (amino acids [3][4][5][6][7][8][9][10][11], which only pairs with the NT-proCNP region.…”

High prevalence of iron deficiency in patients with acute decompensated heart failure

“…17 Iron deficiency in CHF could be related to gradual depletion of iron stores (absolute iron deficiency) due to gastrointestinal blood loss (antiplatelet therapy or oral anticoagulation), poor nutrition, or malabsorption. 18 Chronic systemic inflammation, which is frequently observed in CHF, is responsible for reduced intestinal absorption of iron and reduced availability of recycled iron from senescent blood cells in the reticuloendothelial system (functional iron deficiency). 19 Although iron deficiency is associated with poor outcome in CHF, its prevalence is unknown in decompensated CHF because screening for iron deficiency is uncommon among patients without anaemia, especially in an acute setting.…”

Usefulness of Relative Hypochromia in Risk Stratification for Nonanemic Patients With Chronic Heart Failure

“…25 This could be related to gradual depletion of iron stores (absolute iron deficiency) due to low iron intake, gastrointestinal blood loss, or iron malabsorption. 25 In HF, there is also an activation of pro-inflammatory cytokines that block intestinal absorption of iron and divert iron from the circulation into the reticulo-endothelial system (functional iron deficiency). 2,26 In both scenarios, there is decreased iron availability to targeted tissues and organs.…”