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

Abstract

The purpose of this study is to investigate the impact of a reduction of hemoglobin (Hb) content in the erythrocytes as estimated by mean corpuscular hemoglobin concentration (MCHC) on long-term clinical outcomes in non-anemic patients with heart failure (HF). We prospectively enrolled 1,579 subjects with HF undergoing coronary angiography enrolled in the GeneBank study with 5-year follow-up of all-cause mortality. Levels of Hb and MCHC were assessed at enrollment and after 6 months of follow up. Anemia was defined as Hb levels <13 g/dL in males, and <12 g/dL in females. In our non-anemic cohort (n=785, 49.7%), mean Hb and median MCHC were 13.8±1.1 g/dL and 34.3 (interquartile range 33.6-35) g/dL, respectively. Non-anemic HF patients with lower MCHC had higher mortality risk (Quartiles 1 vs 4, Hazard ratio = 2.1, 95% confidence interval 1.4-3.3, p=0.001). In a subset of non-anemic patients with persistent normal Hb on follow-up (n=206), the mean time between baseline and follow up MCHC levels was 169.3±41.6 days. In comparison to patients with levels of MCHC above the first quartile (≥33.6 g/dL) on baseline and follow up, patients with persistently low MCHC (<33.6 g/dL) had a significantly increased mortality risk (log rank <0.001). All models remained significant even after adjusting for traditional cardiac risk factors, left ventricular ejection fraction, baseline Hb levels and mean corpuscular volume. In conclusion, relative hypochromia is an independent predictor of increased mortality risk in patients with HF, even in the setting of normal Hb levels.

Prevalence, clinical correlates, and outcomes of anaemia in multi‐ethnic Asian patients with heart failure with reduced ejection fraction

“…The prevalence of anaemia in HF has previously been reported in European studies to range between 16% and 53% . Differences in characteristics of the study populations could account for this wide range in prevalence.…”

“…4,16,[24][25][26][27] The prevalence of anaemia in HF has previously been reported in European studies to range between 16% and 53%. 3,[5][6][7][8]12,13,[28][29][30][31][32][33][34][35][36] Differences in characteristics of the study populations could account for this wide range in prevalence. For meaningful comparison with our results, we inspected previous reports using the WHO definition of anaemia and included patients with stable chronic heart failure with reduced ejection fraction.…”

Relative hypochromia and mortality in acute heart failure

“…Anemia was defined as a hemoglobin <12g/dl for woman and <13g/dl for men [19]. Indices of anemia included hemoglobin (determined after lysis of the erythrocytes by the cyanhemoglobin), hematocrit and MCHC (mean corpuscular hemoglobin concentration) and…”

“…Some limitations should be considered when interpreting these findings. First, this study used a surrogate of iron deficiency because routine blood analyses in the ED do not include parameters of iron indices in all patients to evaluate the presence of underlying iron deficiency; nevertheless prior studies have shown a strong correlation between parameters of iron deficiency and MCHC-levels [19]. Therefore, the evaluation of MCHC levels is an indirect measurement of the degree of relative hypochromia in the erythrocytes rather than a measurement of circulating substrates of iron.…”

The Association Between Mean Corpuscular Hemoglobin Concentration and Prognosis in Patients with Acute Pulmonary Embolism: A Retrospective Cohort Study

“…However, Low MCHC is also associated with the prognosis of acute and chronic heart failure. 24 , 26 Subsequently, Cesar Simbaqueba discovered that MCHC is associated with long-term adverse events of right and left ventricular diastolic dysfunction, even independent of RDW and hemoglobin. 27 In contrast, Tomasz Urbanowicz and Serhat Karaman found that high MCHC had a similar role in predicting the severity of carotid artery disease and acute coronary syndromes.…”