Abstract 18078: Anemia is a Marker of Volume Status and is Not Associated With Intrinsic Diastolic Dysfunction or Adverse Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction
Introduction: Anemia is a poor prognostic marker in heart failure with preserved ejection fraction (HFpEF). Prior studies have reported worse diastolic function in anemic HFpEF patients. These studies used only volume-dependent indices of diastolic dysfunction. This is problematic in anemia, a pathologic state characterized by hypervolemia. We hypothesized that anemia is not associated with worse diastolic function when assessed with intrinsic myocardial markers.
Methods: We prospectively studied 419 outpatients in a systematic HFpEF program, all of whom underwent comprehensive echocardiography. Myocardial strain was measured in 311 patients using TomTec speckle tracking software. Follow-up evaluations occurred once every 6 months. The association of anemia with clinical, echocardiographic, and strain variables was studied using linear regression models. Outcomes analysis for cardiovascular hospitalization and death was conducted using Cox proportional hazard models.
Results: 222 (53%) patients were anemic, defined as hemoglobin<13g/dL in men and <12g/dL in women. Anemic patients were more likely to have diabetes and chronic kidney disease. Anemic status was predictive of the combined outcome of cardiovascular hospitalization or death (p<0.001). Anemia was associated with volume (preload)-dependent markers of diastolic dysfunction including echocardiographic E/A and E/e’ ratio and right heart pressures (Table). Anemia was not associated with markers of intrinsic myocardial dysfunction or cardiac mechanics (i.e., e’ velocity, strain [Table]).
Conclusions: In HFpEF, anemia is associated with markers of volume status and not intrinsic markers of myocardial dysfunction. The association of anemia and adverse outcomes in HFpEF is likely due to extracardiac factors, and not intrinsic myocardial dysfunction. Our findings suggest volume status as an important determinant of the apparent worse diastolic function seen in anemia and HFpEF.
Author Disclosures: J.A. Burns: None. L. Beussink: None. V. Daruwalla: None. C. Sanchez: None. S.J. Shah: None.
- © 2016 by American Heart Association, Inc.