Abstract 20009: Vitamin B12 Deficiency in Patients With Heart Failure and Iron-dDficiency Anemia
Anemia is a frequent co-morbidity in heart failure (HF) and correlates with a worse prognosis. Despite that several complex mechanisms were described, the current available therapy of anemia in HF include only erythropoietin agents and/or oral and intravenous iron. Vitamin B12 (Cb) deficiency is frequently overlooked in HF because macrocytosis is masked by concurrent iron deficiency. Few studies dealt with the evaluation of vitamin B12 deficiency in HF, even if in this circumstance there is a higher susceptibility due to age and malnutrition. The purpose of our prospective study was to evaluate the prevalence of vitamin B12 deficiency in advanced HF patients (pt) and the effect of Cb combined with iron therapy on the quality of life and exercise capacity in these pt. We included 112 stable pt, mean age 74±11yrs, LVEF < 0.4 and mean NYHA class 3.1 with functional iron deficiency and Hb < 11.5 g/dl. No patient had macrocytosis. Ferritin and serum Cb level were determined in each pt at the beginning of the study and monthly. Pt were treated with iv. iron and intramuscular Cb (1mg daily for 1 week and then 1mg/week) if the Cb deficiency was present. The mean follow up (FU) was 6± 1.6 mos. Quality of life (QoL) was assesed by the Left Vetricular Dysfunction - 36 (LVD36) dichotomic questionnaire presented to pt. twice, 1–2 weeks apart at baseline and at the end of FU. Exercise capacity was evaluated with 6-minutes corridor walk test (6WT) at the beginning and the end of the study. Cobalamin deficiency was noted in 33 pt (30%). After the FU the LVD-36 assessed QoL was significantly improved vs. baseline (58 % vs. 39 %, p<0.05). This improvement was noted for physical, mental and general health components of LVD-36. There were no significant differences between pt treated with iron or iron plus Cb. 6WT performance was also significantly improved at the end of FU compared to baseline (380m vs. 270m, p:0.05). The improvement of QoL and exercise capacity was not dependent on sex, degree of anemia, mean ejection fraction or etiology.
Conclusions: Cb deficiency should be kept in mind in HF pt with anemia despite the absence of macrocytic pattern, as one third of pt could have this combined form of anemia. Treatment with vitamin B12 adjunct to iron therapy improves the QoL and exercise capacity in these patients.
- © 2010 by American Heart Association, Inc.