β-Erythropoietin Effects on Ventricular Remodeling Left and Right Systolic Function, Pulmonary Pressure, and Hospitalizations in Patients Affected With Heart Failure and Anemia

Department of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, University of Siena, Siena, Italy.
Journal of cardiovascular pharmacology (Impact Factor: 2.14). 06/2009; 53(6):462-7. DOI: 10.1097/FJC.0b013e3181a6ac38
Source: PubMed


Anemia in heart failure is related to advanced New York Heart Association classes, severe systolic dysfunction, and reduced exercise tolerance. Although anemia is frequently found in congestive heart failure (CHF), little is known about the effect of its' correction with erythropoietin (EPO) on cardiac structure and function. The present study examines, in patients with advanced CHF and anemia, the effects of beta-EPO on left ventricular volumes, left ventricular ejection fraction (LVEF), left and right longitudinal function mitral anular plane systolic excursion (MAPSE), tricuspid anular plane excursion (TAPSE), and pulmonary artery pressures in 58 patients during 1-year follow-up in a double-blind controlled study of correction of anemia with subcutaneous beta-EPO. Echocardiographic evaluation, B-Type natriuretic peptide (BNP) levels, and hematological parameters are reported at 4 and 12 months. The patients in group A after 4 months of follow-up period demonstrated an increase in LVEF and MAPSE (P < 0.05 and P < 0.01, respectively) with left ventricular systolic volume reduction (P < 0.02) with respect to baseline and controls. After 12 months, results regarding left ventricular systolic volume LVEF and MAPSE persisted (P < 0.001). In addition, TAPSE increased and pulmonary artery pressures fell significantly in group A (P < 0.01). All these changes occurred together with a significant BNP reduction and significant hemoglobin increase in the treated group. Therefore, we revealed a reduced hospitalization rate in treated patients with respect to the controls (25% in treated vs. 54% in controls). In patients with anemia and CHF, correction of anemia with beta-EPO and oral iron over 1 year leads to an improvement in left and right ventricular systolic function by reducing cardiac remodeling, BNP levels, and hospitalization rate.

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    • "Heart failure: Recombinant EPO therapy has been found to be useful in patients with heart failure, especially with the cardio-renal anemia syndrome.[48] Some recent studies show reduction in cardiac remodeling, Brain Natriuretic eptide levels, and hospitalization rate, resulting in improvement in left and right ventricular systolic function.[49] "
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    ABSTRACT: Recombinant human erythropoietin (rhEPO) is arguably the most successful therapeutic application of recombinant DNA technology till date. It was isolated in 1977 and the gene decoded in 1985. Since then, it has found varied applications, especially in stimulating erythropoiesis in anemia due to chronic conditions like renal failure, myelodysplasia, infections like HIV, in prematurity, and in reducing peri-operative blood transfusions. The discovery of erythropoietin receptor (EPO-R) and its presence in non-erythroid cells has led to several areas of research. Various types of rhEPO are commercially available today with different dosage schedules and modes of delivery. Their efficacy in stimulating erythropoiesis is dose dependent and differs according to the patient's disease and nutritional status. EPO should be used carefully according to guidelines as unsolicited use can result in serious adverse effects. Because of its capacity to improve oxygenation, it has been abused by athletes participating in endurance sports and detecting this has proved to be a challenge.
    03/2012; 16(2):220-7. DOI:10.4103/2230-8210.93739
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    ABSTRACT: Anemia is a common comorbidity in heart failure (HF), and is associated with increased morbidity and mortality. However, it remains unclear whether anemia is merely a marker of poor prognosis or whether anemia itself confers risk. The pathogenesis of anemia in HF is multifactorial. Iron deficiency also confers risk in HF, either with or without associated anemia, and treatment of iron deficiency improves the functional status of patients with HF. An ongoing large clinical trial studying the use of darbepoetin–alfa in patients with anemia and systolic HF is expected to provide information that should improve our understanding of anemia in HF.
    Current Heart Failure Reports 09/2012; 9(4). DOI:10.1007/s11897-012-0112-x
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    ABSTRACT: Randomized controlled trials (RCTs) evaluating the efficacy and safety of erythropoiesis-stimulating agents (ESAs), including erythropoietin and darbepoetin, among patients with chronic heart failure (CHF) and anemia have yielded heterogeneous results, and important safety questions remain unanswered. We therefore undertook a meta-analysis to examine the effects of ESAs in this population. We systematically searched EMBASE, Medline, the Cochrane Library,, and relevant bibliographies to identify all relevant RCTs. Data were aggregated using random-effects models. We identified 9 RCTs (n = 747 patients). Compared with control, ESAs were associated with a significant reduction in CHF-related hospitalizations (odds ratio [OR] = 0.41; 95% confidence interval [CI] = 0.24-0.69). The effect of ESAs on mortality was inconclusive (OR = 0.60; 95% CI = 0.32-1.11). ESAs were associated with improved quality of life and left ventricular ejection fraction, lower brain-natriuretic peptide levels, and improved exercise tolerance test performance. There was no evidence of an increase in the incidence of adverse events among patients randomized to ESAs (OR = 0.86; 95% CI = 0.51-1.42). In patients with CHF and anemia, ESAs are associated with a decrease in CHF-related hospitalizations and improved quality of life and exercise tolerance. However, RCTs completed to date have involved a small number of patients, and available mortality data are inconclusive.
    Journal of cardiac failure 08/2010; 16(8):649-58. DOI:10.1016/j.cardfail.2010.03.013 · 3.05 Impact Factor
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