β-Erythropoietin Effects on Ventricular Remodeling Left and Right Systolic Function, Pulmonary Pressure, and Hospitalizations in Patients Affected With Heart Failure and Anemia
ABSTRACT 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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ABSTRACT: Anemia is a common comorbidity in patients with chronic heart failure (CHF) and is frequently treated with erythropoiesis-stimulating proteins (ESPs). Previous studies, however, have been relatively short in duration and have not provided conclusive data on the safety or clinical efficacy of ESP treatment. The aim of this study was to explore the safety and therapeutic effects of ESPs in patients with anemia and CHF. A systematic literature search in EMBASE and MEDLINE from their inception to July 2013 was performed, and clinical studies that evaluated the effects of ESPs among patients with CHF were identified. Randomized clinical trials comparing the effects of ESP treatment with those of placebo treatment or usual care regimes in anemic patients with CHF were included. Nine randomized, controlled trials were identified, comprising 750 patients with CHF and anemia receiving ESP treatment for between three months and one year. ESP treatment had a significantly lower risk of CHF hospitalization [relative risk (RR), 0.47; 95% confidence interval (CI), 0.32-0.70; P=0.0002] and a moderate reduction in mortality risk (RR, 0.68; 95% CI, 0.38-1.19; P=0.18). Treatment with ESPs in patients with symptomatic CHF and anemia resulted in significant improvements in hemoglobin, hematocrit and brain natriuretic peptide levels, as well as exercise capacity, renal function, New York Heart Association class and left ventricular ejection fraction. In conclusion, this study found that treatment with ESPs exerts beneficial effects against CHF and is not associated with a higher mortality rate or adverse effects. These outcomes support the instigation of a trial evaluating the treatment of anemia with ESPs in patients with chronic CHF.Experimental and therapeutic medicine 09/2014; 8(3):863-870. DOI:10.3892/etm.2014.1845 · 0.94 Impact Factor
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ABSTRACT: Anemia is a negative prognostic marker in patients with chronic heart failure, whether the ejection fraction is depressed or preserved. The majority of patients with chronic heart failure and anemia present with chronic renal failure. These three conditions (i.e. heart failure, kidney failure and anemia) are interrelated and self-perpetuating. The combination is known as cardiorenal anemia syndrome. Conversely, iron deficiency is common in patients with chronic heart failure and is believed to have a multifactorial origin. Therefore, recommended treatment for anemia in these patients is based on the administration of erythropoiesis-stimulating agents and iron therapy. The most commonly used agents in our field are recombinant human epoetin beta, darbepoetin alfa and continuous erythropoietin receptor activators. Most research shows that these agents increase hemoglobin levels, reduce levels of risk markers such as N-terminal probrain natriuretic peptide (NT-proBNP) and improve functional capacity. Some studies even show favorable changes in cardiac remodeling parameters. Iron therapy primarily involves iron sucrose and ferric carboxymaltose. Randomized placebo-controlled trials show that, in patients with iron deficiency, these compounds increase hemoglobin levels, improve functional class and 6-min walk test results, decrease the levels of risk markers such as natriuretic peptides, and improve quality of life as assessed using both specific questionnaires for patients with chronic heart failure and generic questionnaires. However, no well-designed studies have been carried out in a sufficiently large number of patients using «hard» primary endpoints. It is to be hoped that well-designed trials that include assessments of all key variables (i.e. rehospitalization, death and long-term safety) will be carried out in coming years.Revista Española de Cardiología Suplementos 01/2012; 12:21–26. DOI:10.1016/S1131-3587(12)70036-5
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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