Anemia is a commonly occurring comorbidity among patients of heart failure with preserved ejection fraction (HFpEF) but limited data exists on the cardiovascular phenotype of anemia in HFpEF. We sought to characterize the clinical features, exercise capacity, and outcomes in patients with HFpEF to elucidate the phenotype and pathophysiology of anemia in HFpEF. Post hoc analyses of participants enrolled in the RELAX (Phosphodiesterase-5 Inhibition to Improve Clinical Status and Exercise Capacity in Diastolic Heart Failure) trial was performed. Anemia was defined as hemoglobin <13 g/dL in men and <12 g/dL in women. Multivariate adjusted regression modeling was done to assess for differences in peak oxygen uptake. Adjusted hazard ratios were generated to assess difference in hospitalization events using a Cox proportional hazards model. Anemic HFpEF patients were more likely to be older, male, and have worse renal function (p <0.05 for all). N-terminal pro-B-type natriuretic peptide, troponin I, pro-collagen III N-terminal peptide, C-telopeptide for type I collagen, uric acid, cystatin-c, and galectin-3 (p <0.05 for all) levels were higher in anemic HFpEF patients. In adjusted models, anemic HFpEF patients had worse exercise capacity (peak oxygen uptake: 11.3 vs 12.1 mL/kg/min; p = 0.004). The hazard for cardiac or renal cause of hospitalization in those with anemia was 2.0 (95% confidence interval: 0.9 to 4.3). Anemic HFpEF patients have worse exercise capacity and are more likely to be hospitalized. A better understanding of the physiologic phenotypes of HFpEF patients may allow for greater personalization of treatment and prognostication in HFpEF patients.
|Original language||English (US)|
|Number of pages||9|
|Journal||American Journal of Cardiology|
|State||Published - Jun 15 2020|
Bibliographical noteFunding Information:
Funding: This work is supported by the Minority Health & Health Disparities Research Center, National Institute of Minority Health and Health Disparities [ U54MD000502 ], and the National Institutes of Health Mentored-Patient Oriented Research Award [ 5K23 HL146887-02 ] to Dr. Pankaj Arora.
The RELAX trial was a multicenter, randomized, double-blind, placebo-controlled, 24-week trial conducted by the Heart Failure Clinical Research Network and funded by the National Heart, Lung, and Blood Institute (NHLBI). 5 The trial was conducted between October 1, 2009, and February 1, 2012, in 216 (215 with data on anemia) stable HFpEF patients enrolled across 26 centers in the United States and Canada randomized to 24-weeks of sildenafil versus placebo. The data for current analyses were obtained from the NHLBI BioLINCC data repository. Anemia was defined as hemoglobin <13g/dL in men and <12 g/dL in women. The study was conducted in accordance with the principles in the Declaration of Helsinki. Written and informed consent was obtained from all participants in the parent trial and the trial was approved by protocol review and data safety monitoring committee and the institutional review board at the respective sites. 6
Funding: This work is supported by the Minority Health & Health Disparities Research Center, National Institute of Minority Health and Health Disparities [U54MD000502], and the National Institutes of Health Mentored-Patient Oriented Research Award [5K23 HL146887-02] to Dr. Pankaj Arora.
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