Prevalence, Prognosis, and Therapeutic Implications of Unrecognized Left Ventricular Systolic Dysfunction in Patients With Anemia and Chronic Kidney Disease
Version of Record online: 5 AUG 2010
© 2010 Wiley Periodicals, Inc.
Congestive Heart Failure
Volume 16, Issue 6, pages 271–277, November/December 2010
How to Cite
Bhatti, S., Hakeem, A., Dillie, K. S., Cook, J. R. and Chang, S. M. (2010), Prevalence, Prognosis, and Therapeutic Implications of Unrecognized Left Ventricular Systolic Dysfunction in Patients With Anemia and Chronic Kidney Disease. Congestive Heart Failure, 16: 271–277. doi: 10.1111/j.1751-7133.2010.00181.x
- Issue online: 21 NOV 2010
- Version of Record online: 5 AUG 2010
- Manuscript received April 26, 2010; revised June 22, 2010; accepted June 23, 2010
The prevalence and outcomes of unrecognized left ventricular dysfunction (ULVSD) in patients with anemia and chronic kidney disease (CKD) is not known. The authors determined whether anemia (hemoglobin <13 g/L) and CKD (glomerular filtration rate <60 mL/min) are risk factors for ULVSD (ejection fraction <35%, no known heart failure [HF]) and to determine its impact on clinical outcomes. A total of 1358 patients without history of HF undergoing gated myocardial perfusion single photon emission computed tomography for evaluation of suspected coronary artery disease were followed for a mean of 2.15±0.8 years. End points were death and heart failure hospitalization (HFH). Patients were divided into 4 groups (I: no anemia/no CKD, n=752; II: CKD/no anemia, n=285; III: anemia/no CKD, n=153; IV: anemia+CKD, n=168). Compared with group I, LVSD was significantly more common in group IV (11.3% vs 4%; P=.0009). Death and HFH were significantly higher in group IV compared with group I (death rate for group I: 3.5% per year vs group IV: 12% per year; P<.0001) (HFH rate for group I: 1.5% per year vs group IV: 8% per year, P<.0001). Among patients with ejection fraction <35%, presence of anemia+CKD was associated with a relative risk of 2.48 (95% confidence interval, 1.13–5.4; P=.02) for death compared with group I. Among patients with ULVSD, only 65% were taking angiotensin enzyme inhibitors/angiotensin receptor blockers and β-blockers. ULVSD was almost 3 times more common in patients with anemia+CKD compared with those without and was associated with a significantly higher risk of death and HFH. It may therefore be beneficial to screen patients with anemia and CKD for ULVSD, since early therapy may improve outcomes. Congest Heart Fail. 2010;16:271–277. © 2010 Wiley Periodicals, Inc.