Abstract 2367: Effects of Recombinant Human Erythropoietin on Left Ventricular Diastolic and Systolic Function, and Plasma Biomarkers of Neurohormonal Activation in Patients with Chronic Heart Failure and Anemia
Anemia is a frequent comorbid condition in chronic heart failure (CHF) affecting adversely patient prognosis. Erythropoietin (EPO) administration seems to restore hemoglobin (Hb) levels and improve exercise capacity in CHF patients. We sought to investigate if recombinant human EPO (rhEPO) affects beneficially markers of left ventricular (LV) diastolic and systolic function, and neurohormonal activation in patients with CHF and anemia (Hb <12.5 g/dl).
Methods: Twenty-six CHF patients [NYHA class: 3.0 ±0.7; LV ejection fraction (EF): 26±5%; Hb:11.2±0.8 g/dl; serum creatinine <2.5 mg/dl] were randomized (2:1) to receive either 3-month rhEPO (n=17) (darbepoietin-alpha: 1.5 μg/Kg every 15 days s.c.) plus ferrum orally or placebo (n=9) plus ferrum orally. Echocardiographic markers of LV diastolic (E, A filling velocities, ratio E/A, deceleration time DT of E, tissue Doppler imaging e wave, ratio E/e) and systolic function [LVEF, end-systolic wall stress (ESWS)], plasma B-type natriuretic peptide (BNP), serum C-reactive protein (CRP), and 6-min walk test were assessed before and after the 3-month treatment.
Results: DT of E (152±65 vs 171±67 msec, p=0.05), ratio E/e (11.7±3.3 vs 9.6±3.6, p<0.01), LVEF (23±5 vs 30±6 %, p<0.01) and ESWS (147±64 vs 113±34 g/cm2, p<0.01) were improved only in the rhEPO-treated group. Additionally, in rhEPO-treated patients, BNP (1280±128 vs 824±93 ng/ml, p<0.01) and CRP (12.1±8.7 vs 9.2±5.7 ng/ml, p<0.05) levels were significantly reduced, while Hb (11.0±0.8 vs12.9±1.5 g/dl, p<0.01) and 6-min walk distance (231±108 vs 318±109 m, p<0.01) significantly increased. No significant changes of all these parameters were observed in the placebo-treated arm. RhEPO-induced increase of Hb was significantly correlated with the respective reduction of BNP (r=−0.55, p<0.05) and ESWS (r= −0.60, p<0.05).
Conclusions: RhEPO administration improves markers of LV diastolic and systolic function in CHF patients with anemia, reducing also peripheral neurohormonal response and improving patient exercise capacity.