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. 2023 Dec;46(12):1495-1503.
doi: 10.1002/clc.24141. Epub 2023 Aug 30.

Importance of anemia in heart failure over blood pressure variability

Shunsuke Kiuchi  1 , Shinji Hisatake  1 , Takayuki Kabuki  1 , Shintaro Dobashi  1 , Yoshiki Murakami  1 , Takanori Ikeda  1
Affiliations

Importance of anemia in heart failure over blood pressure variability

Shunsuke Kiuchi et al. Clin Cardiol. 2023 Dec.

Abstract

Background: The evaluation of arteriosclerosis (vascular function) is important when treating heart failure (HF). Vascular dysfunction is associated with anemia through renal function and endothelial nitric oxide synthase. Additionally, blood pressure (BP) variability (BPV) caused by vascular dysfunction is also associated with HF prognosis. However, how anemia and BPV may affect HF prognosis is unclear.

Methods: Between January 2012 and July 2018, 214 patients with HF were hospitalized. The cardio-ankle vascular index (CAVI) as an index of arteriosclerosis of these patients was measured. The patients were divided into the elevated and preserved CAVI groups. We investigated the factors related to major adverse cardiovascular events (MACEs) as cardiovascular death or rehospitalization within 1 year after discharge.

Results: In the elevated CAVI group, significant differences in body mass index (BMI), BPV, left ventricular dimension, and hemoglobin levels were observed between patients with and without MACEs. In the preserved CAVI group, significant differences in BMI, diastolic/mean BP, and hemoglobin levels were observed between those with and without MACEs. The multivariate analysis showed an independent association between hemoglobin levels and MACE occurrence in both the elevated and preserved CAVI groups (elevated CAVI group: hazard ratio [HR] = 0.800, p = .045 [model 1], HR = 0.802, p = .035 [model 2]; preserved CAVI group: HR = 0.783, p = .049 [model 1], HR = 0.752, p = .023 [model 2], and HR = 0.754, p = .024 [model 3]).

Conclusions: Anemia was independently associated with HF prognosis with or without arteriosclerosis.

Keywords: anemia; blood pressure in-hospital variability; cardio ankle-brachial index; heart failure; prognosis.

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Conflict of interest statement

T. I. received research funds and lecture fees from Daiichi‐Sankyo, Co., Ltd., Bayer Healthcare, Co., Ltd., and Bristol‐Myers Squibb, Co., Ltd. The remaining author declares no conflict of interest.

Figures

Figure 1
Figure 1
MACE within 1 year after discharge in the elevated CAVI group. MACE within 1 year after discharge in patients with low hemoglobin (<13.1 g/dl) was significantly higher than high hemoglobin (≥13.1 g/dl). p Values were determined using the log‐rank test. CAVI, cardio ankle vascular index; MACE, major adverse cardiovascular events.
Figure 2
Figure 2
MACE within 1 year after discharge in the preserved CAVI group. MACE within 1 year after discharge in patients with low hemoglobin (<13.7 g/dl) was significantly higher than high hemoglobin (≥13.7 g/dl). p Values were determined using the log‐rank test. CAVI, cardio ankle vascular index; MACE, major adverse cardiovascular events.
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