Anemic Syndrome in Patients with Chronic Heart Failure

Anemic syndrome is a common comorbidity in patients with chronic heart failure (CHF) and is associated with an increased risk of mortality and high hospitalization rates. The purpose of our investigations was to study survival of patients with CHF depending of the concentration of hemoglobin and the realtionship between anemic syndrome and hemostasis, structural-functional state of the heart. Materials and methods. This study involved 121 male patients aged 36-78 (median 59 years) diagnosed with chronic heart failure (CHF) on the background of coronary heart disease (stable angina, prior myocardial infarction and after coronary bypass surgery and stenting). The diagnosis was set on the basis of clinical and laboratory assessments, ECG data, echocardiography, bicycle ergometry, coronarography. We examined parameters of hemostasis: platelet count in peripheral blood and their aggregation with ADP, fibrinogen, soluble fibrin-monomer (FM), D-dimer, ethanol gelation test and prothrombin index. Glomerular filtration (GF) was calculated by using formula Snyder S. et al., 2005. The diagnosis of anemia was confirmed at the concentration of hemoglobin less than 130 g/l. We divided patients into two groups: group 1 comprised 39 (32%) patients with CHF and anemic syndrome and group 2 consisted of 82 (68%) patients with CHF without anemic syndrome. Statistical analysis was done using Statistica for Windows 5.0 program. Data are presented as the median [lower-upper quartiles]; comparisons between groups were made using the Mann-Whitney U-test. Categorical data were assessed using the Fisher exact test, the correlation between variables – by Kendall's correlation test, survival curves during 36 months – by the Kaplan-Meier method with significant difference between the groups – by Cox's F-test and Hehan-Wilcoxon test. Results and discussion. To assess the course of chronic heart failure patients we took those who had been under observation for 3 years after clinical examination. The final point of observation was the registration of acute cardiovascular complications: acute coronary syndrome, stroke, peripheral thrombosis. Retrospective analysis of prognostic value showed that аnemic syndrome was the main predictor of future acute cardiovascular events in patients with chronic heart failure. The cumulative proportion of survival (by the Kaplan-Meier method) in patients with CHF and аnemic syndrome was 58,9%, whereas in patients without аnemic syndrome it was 82,3% (Cox's F-test, p=0.01; Hehan-Wilcoxon test, p=0.053). According to results of correlation analysis a significant inverse correlation was found between hematocrit and soluble FM (τ=-0,329, р=0,007), fibrinogen (τ=-0,280, р=0,007); between soluble FM and average hemoglobin content of the erythrocytes (МСН) (τ=-0,563, р<0,001). The degree of renal dysfunction had a clear dependence on the severity of СHF and the presence of anemia, there was a significant inverse correlation between the parameters GF and functional class heart failure (τ=-0,284, р=0,03), end-diastolic dimension left ventricle (LV) (τ=-0,212, р=0,007) and a direct connection between GF and LV ejection fraction (τ=+0,182, р=0,02), platelet aggregation (τ=-0,257, р=0,05), red blood cells count (τ=+0,161, р=0,04), hemoglobin (τ=+0,145, р=0,03), hematocrit (τ=+0,259, р=0,04). Conclusions. Anemic syndrome in patients with heart failure is associated with worse survival during 6 months, one, two and three years of observation. The development of anemia in patients with CHF may be associated with systolic dysfunction and left ventricular dilatation, renal dysfunction and hypercoagulation, which is important to consider in treatment.