DOI QR코드

DOI QR Code

Effect of anemia correction on left ventricular structure and filling pressure in anemic patients without overt heart disease

  • Cho, In-Jeong (Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine) ;
  • Mun, Yeung Chul (Division of Hematology and Oncology, Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Kwon, Ki Hwan (Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine) ;
  • Shin, Gil Ja (Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine)
  • Received : 2013.08.03
  • Accepted : 2013.10.28
  • Published : 2014.07.01

Abstract

Background/Aims: There are few data on the effects of low hemoglobin levels on the left ventricle (LV) in patients without heart disease. The objective of this study was to document changes in the echocardiographic variables of LV structure and function after the correction of anemia without significant cardiovascular disease. Methods: In total, 34 iron-deficiency anemia patients ($35{\pm}11$ years old, 32 females) without traditional cardiovascular risk factors or cardiovascular disease and 34 age- and gender-matched controls were studied. Assessments included history, physical examination, and echocardiography. Of the 34 patients with anemia enrolled, 20 were followed and underwent echocardiography after correction of the anemia. Results: There were significant differences between the anemia and control groups in LV diameter, left ventricular mass index (LVMI), left atrial volume index (LAVI), peak mitral early diastolic (E) velocity, peak mitral late diastolic (A) velocity, E/A ratio, the ratio of mitral to mitral annular early diastolic velocity (E/E'), stroke volume, and cardiac index. Twenty patients underwent follow-up echocardiography after treatment of anemia. The follow-up results showed significant decreases in the LV end-diastolic and end-systolic diameters and LVMI, compared with baseline levels. LAVI, E velocity, and E/E' also decreased, suggesting a decrease in LV filling pressure. Conclusions: Low hemoglobin level was associated with larger cardiac chambers, increased LV, mass and higher LV filling pressure even in the subjects without cardiovascular risk factors or overt cardiovascular disease. Appropriate correction of anemia decreased LV mass, LA volume, and E/E'.

Keywords

References

  1. Aessopos A, Deftereos S, Farmakis D, et al. Cardiovascular adaptation to chronic anemia in the elderly: an echocardiographic study. Clin Invest Med 2004;27:265-273.
  2. Felker GM, Adams KF Jr, Gattis WA, O'Connor CM. Anemia as a risk factor and therapeutic target in heart failure. J Am Coll Cardiol 2004;44:959-966. https://doi.org/10.1016/j.jacc.2004.05.070
  3. Mozaffarian D, Nye R, Levy WC. Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE). J Am Coll Cardiol 2003;41:1933-1939. https://doi.org/10.1016/S0735-1097(03)00425-X
  4. Anand I, McMurray JJ, Whitmore J, et al. Anemia and its relationship to clinical outcome in heart failure. Circulation 2004;110:149-154. https://doi.org/10.1161/01.CIR.0000134279.79571.73
  5. Rakusan K, Cicutti N, Kolar F. Effect of anemia on cardiac function, microvascular structure, and capillary hematocrit in rat hearts. Am J Physiol Heart Circ Physiol 2001;280:H1407-H1414. https://doi.org/10.1152/ajpheart.2001.280.3.H1407
  6. Amin MG, Tighiouart H, Weiner DE, et al. Hematocrit and left ventricular mass: the Framingham Heart study. J Am Coll Cardiol 2004;43:1276-1282. https://doi.org/10.1016/j.jacc.2003.10.048
  7. Srivastava PM, Thomas MC, Calafiore P, MacIsaac RJ, Jerums G, Burrell LM. Diastolic dysfunction is associated with anaemia in patients with type II diabetes. Clin Sci (Lond) 2006;110:109-116. https://doi.org/10.1042/CS20050184
  8. Nair D, Shlipak MG, Angeja B, Liu HH, Schiller NB, Whooley MA. Association of anemia with diastolic dysfunction among patients with coronary artery disease in the Heart and Soul Study. Am J Cardiol 2005;95:332-336. https://doi.org/10.1016/j.amjcard.2004.09.029
  9. Bahl VK, Malhotra OP, Kumar D, et al. Noninvasive assessment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study. Am Heart J 1992;124:1516-1523. https://doi.org/10.1016/0002-8703(92)90066-5
  10. Pappas KD, Gouva CD, Katopodis KP, et al. Correction of anemia with erythropoietin in chronic kidney disease (stage 3 or 4): effects on cardiac performance. Cardiovasc Drugs Ther 2008;22:37-44. https://doi.org/10.1007/s10557-007-6075-6
  11. Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalence of iron def iciency in the United States. JAMA 1997;277:973-976. https://doi.org/10.1001/jama.1997.03540360041028
  12. Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 2005;18:1440-1463. https://doi.org/10.1016/j.echo.2005.10.005
  13. Devereux RB, Alonso DR, Lutas EM, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-458. https://doi.org/10.1016/0002-9149(86)90771-X
  14. Benjamin EJ, D'Agostino RB, Belanger AJ, Wolf PA, Levy D. Left atrial size and the risk of stroke and death: the Framingham Heart Study. Circulation 1995;92:835-841. https://doi.org/10.1161/01.CIR.92.4.835
  15. Ren JF, Kotler MN, DePace NL, et al. Two-dimensional echocardiographic determination of left atrial emptying volume: a noninvasive index in quantifying the degree of nonrheumatic mitral regurgitation. J Am Coll Cardiol 1983;2:729-736. https://doi.org/10.1016/S0735-1097(83)80313-1
  16. Horwich TB, Fonarow GC, Hamilton MA, MacLellan WR, Borenstein J. Anemia is associated with worse symptoms, greater impairment in functional capacity and a significant increase in mortality in patients with advanced heart failure. J Am Coll Cardiol 2002;39:1780-1786. https://doi.org/10.1016/S0735-1097(02)01854-5
  17. Ponikowski P, Anker SD, Szachniewicz J, et al. Effect of darbepoetin alfa on exercise tolerance in anemic patients with symptomatic chronic heart failure: a randomized, double-blind, placebo-controlled trial. J Am Coll Cardiol 2007;49:753-762. https://doi.org/10.1016/j.jacc.2006.11.024
  18. Silverberg DS, Wexler D, Sheps D, et al. The effect of correction of mild anemia in severe, resistant congestive heart failure using subcutaneous erythropoietin and intravenous iron: a randomized controlled study. J Am Coll Cardiol 2001;37:1775-1780. https://doi.org/10.1016/S0735-1097(01)01248-7
  19. Bolger AP, Bartlett FR, Penston HS, et al. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. J Am Coll Cardiol 2006;48:1225-1227. https://doi.org/10.1016/j.jacc.2006.07.015
  20. Sarnak MJ, Tighiouart H, Manjunath G, et al. Anemia as a risk factor for cardiovascular disease in The Atherosclerosis Risk in Communities (ARIC) study. J Am Coll Cardiol 2002;40:27-33. https://doi.org/10.1016/S0735-1097(02)01938-1
  21. Lester SJ, Tajik AJ, Nishimura RA, Oh JK, Khandheria BK, Seward JB. Unlocking the mysteries of diastolic function: deciphering the Rosetta Stone 10 years later. J Am Coll Cardiol 2008;51:679-689. https://doi.org/10.1016/j.jacc.2007.09.061
  22. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular f illing pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-1794. https://doi.org/10.1161/01.CIR.102.15.1788
  23. Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant 2000;15 Suppl 3:14-18.
  24. Labovitz AJ, Lewen MK, Kern M, Vandormael M, Deligonal U, Kennedy HL. Evaluation of left ventricular systolic and diastolic dysfunction during transient myocardial ischemia produced by angioplasty. J Am Coll Cardiol 1987;10:748-755. https://doi.org/10.1016/S0735-1097(87)80266-8
  25. Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr 2009;10:165-193. https://doi.org/10.1093/ejechocard/jen204
  26. Lester LA, Sodt PC, Hutcheon N, Arcilla RA. Cardiac abnormalities in children with sickle cell anemia. Chest 1990;98:1169-1174. https://doi.org/10.1378/chest.98.5.1169

Cited by

  1. Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure? vol.16, pp.6, 2014, https://doi.org/10.3390/ijms160614056
  2. Sickle cell anemia mice develop a unique cardiomyopathy with restrictive physiology vol.113, pp.35, 2014, https://doi.org/10.1073/pnas.1600311113
  3. Risk factors for premature ventricular contractions in young and healthy adults vol.103, pp.9, 2017, https://doi.org/10.1136/heartjnl-2016-309632
  4. Assessment of left ventricular systolic function in patients with iron deficiency anemia by three-dimensional speckle-tracking echocardiography vol.18, pp.3, 2014, https://doi.org/10.14744/anatoljcardiol.2017.7694
  5. Higher blood pressure during light exercise is associated with increased left ventricular mass index in normotensive subjects vol.41, pp.5, 2014, https://doi.org/10.1038/s41440-018-0028-2
  6. Characteristics of the Heart of School-Age Children in a Schistosomiasis Endemic Area in Senegal vol.8, pp.9, 2014, https://doi.org/10.4236/wjcd.2018.89043
  7. Evaluation of left atrial volume and function by real time three-dimensional echocardiography in anemic patients without overt heart disease before and after anemia correction vol.35, pp.9, 2019, https://doi.org/10.1007/s10554-019-01609-6
  8. Uncinariasis: una causa poco común de anemia severa vol.34, pp.3, 2014, https://doi.org/10.22516/25007440.250
  9. Association of Left Ventricular Hypertrophy with Hemoglobin Levels in Nonanemic and Anemic Populations vol.145, pp.8, 2014, https://doi.org/10.1159/000508034
  10. Subclinical macro and microvascular disease is differently associated with depressive symptoms in men and women: Findings from the SABRE population-based study vol.312, pp.None, 2014, https://doi.org/10.1016/j.atherosclerosis.2020.09.005
  11. Anemia in pregnancy: it’s effect on oxidative stress and cardiac parameters vol.34, pp.1, 2021, https://doi.org/10.1080/14767058.2020.1813709