Impact of Anemia on Exercise and Pharmacologic Stress Echocardiography

Bird, Jared G.; Morant, Kareem; Al-Souri, Deema; Scott, Christopher G.; Padang, Ratnasari; McCully, Robert B.; Kane, Garvan C.; Pellikka, Patricia A.; Luis, Sushil Allen

doi:10.1016/j.echo.2020.04.003

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…In addition, the underutilization of dual antiplatelets and statins might also be a potential cause of adverse clinical outcomes 16,17 . From a pathophysiological point of view, the necessary condition for coronary artery disease is an imbalance between cardiac oxygen supply and demand, and the presence of anemia further exacerbates the disequilibrium by decreasing oxygen‐carrying capacity while increasing oxygen consumption 16,18 . Furthermore, peripheral blood endothelial progenitor cells in acute coronary syndrome patients with anemia reduced in number and impaired function, indicating that the poor vascular healing capacity might also be involved as a part of the reason 19 …”

Section: Discussionmentioning

confidence: 99%

“… 16 , 17 From a pathophysiological point of view, the necessary condition for coronary artery disease is an imbalance between cardiac oxygen supply and demand, and the presence of anemia further exacerbates the disequilibrium by decreasing oxygen‐carrying capacity while increasing oxygen consumption. 16 , 18 Furthermore, peripheral blood endothelial progenitor cells in acute coronary syndrome patients with anemia reduced in number and impaired function, indicating that the poor vascular healing capacity might also be involved as a part of the reason. 19 Thirdly, aseptic inflammation mediated by immune response played an important role in coronary heart disease, including promoting atherosclerotic plaque formation and plaque instability, 20 meanwhile anemia and inflammation interacted together to lead to unfavorable clinical events compared to patients without anemia.…”

Section: Discussionmentioning

confidence: 99%

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Association between serum hemoglobin and major cardiovascular adverse event in Chinese patients with ST‐segment elevation myocardial infarction after percutaneous coronary intervention

Yang

Huang

2021

Clinical Laboratory Analysis

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Background ST‐segment elevation myocardial infarction (STEMI) is a common clinical acute and severe disease, and it is of great significance to evaluate the prognosis of these patients. Hemoglobin levels are associated with a variety of diseases, but studies on Chinese patients with STEMI after percutaneous coronary intervention (PCI) have not been sufficient. Methods This was a secondary analysis based on a prospective cohort study of patients undergoing PCI in Taizhou, Zhejiang, China. We performed multivariable logistic regression to explore the association between the serum hemoglobin and the incidence of major cardiovascular adverse event (MACE) in patients after PCI. We also used a generalized additive model and smooth curve fitting to explain the nonlinear relationship after adjusting the potential confounders. Finally, the heterogeneity among specific groups was examined by subgroup analysis. Results Of all 462 patients enrolled in this study, 118 (25.54%) developed MACE. There was a negative correlation between serum hemoglobin and MACE in all three models (hazard ratio [HR] 0.82, 95% confidence interval [CI 0.72, 0.93], HR 0.86, 95% CI [0.76,0.98], and HR 0.87, 95% CI [0.74,0.98], respectively). In the subgroup analysis, the negative correlation existed between the patients who had myocardial infarction (MI) history (p for interaction = 0.0059) after adjusting covariates. However, no significant differences were found between age and sex groups (p for interaction = 0.1381, 0.4103, respectively). Conclusion Our results indicated that patients who received PCI with low preoperative hemoglobin were more likely to develop MACE, especially if they have already had a history of MI.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Association between serum hemoglobin and major cardiovascular adverse event in Chinese patients with ST‐segment elevation myocardial infarction after percutaneous coronary intervention

Yang

Huang

2021

Clinical Laboratory Analysis

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“…Some of these compensatory mechanisms involve an increased cardiac activity to reduce the blood circulatory time. Anemia is indeed one of the hyperdynamic situations that will stimulate the cardiomyocytes to release NT-proBNP [9].…”

Section: Introductionmentioning

confidence: 99%

Can Anemia Be a Confounder in Nt-Probnp Interpretation?

Khazaal¹

2022

Int. J. Med. Sci.

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Heart failure is a major clinical issue of concern worldwide. Many biomarkers are used to aid the diagnosis of heart failure patients. One of the increasingly used biomarkers is the biologically inactive NT-proBNP. Several confounding factors affect plasma NT-proBNP levels, and hence, the validity of its interpretation. Heart failure and anemia are well correlated, as evidenced by variety of studies. In, anemia can yield some degree of cardiac stress that leads to the expression of NT-proBNP levels above the cut-off values. This study aimed to test whether anemia can be associated with an elevated peptide level in patients without heart failure. A cross-sectional study in which a total of 108 randomly selected patients, irrespective of their hemoglobin levels, were recruited. Males comprised 39.8% of the total, and the patients were divided based on their hemoglobin levels into anemic (55 patients) and non-anemic (53 patients) groups. Plasma NT-proBNP levels were assessed using ELISA, and the results were interpolated and analyzed against hemoglobin levels. The NT-proBNP level was significantly higher in patients with anemia (p < .0001) where it was 268.7 ± 38.9 vs. 93.55 ± 17.4 ng/dl for both the anemic and non-anemic groups, respectively. Hemoglobin level showed a negative correlation with plasma peptide level ([F (1, 107) = 28.63, p < .0001)], with an r2 of 0.358. Anemia is inversely correlated with the plasma NT-proBNP level. In fact, anemia can raise the peptide level beyond its recommended cutoff levels making the interpretation of the raised NT-proBNP more challenging.

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