Relationship of Hemoglobin and Hematocrit to Systolic Function in Advanced Heart Failure
Exclusive author commentary
Guglin M et al. – In Heart Failure, anemia is associated with poor prognosis and functional impairment, but also with mildly improved systolic function. It may represent an adaptive reaction to congestion.
Maya Guglin (08/09/2012) comments:
The dataset from the ESCAPE trial provides a rare opportunity to evaluate the whole spectrum of effects of anemia in advanced heart failure. Both hemoglobin and hematocrit were measured at different points of time, as well as symptoms, functional capacity, biomarkers, invasive and noninvasive hemodynamics, and outcomes. We confirmed the known association of anemia with poor outcomes and functional status. One gram of increase in hemoglobin was linked to reduction of more than two days of hospital stay over the six months study period. But more interestingly, we found something not reported previously: the inverse relationship between hemoglobin and left ventricular and right ventricular systolic function. According to our data, decreased hemoglobin was associated with better systolic function of the both ventricles and with higher systolic flows measured by time velocity integrals on echo. We speculate that this may be due to lower viscosity which makes work of pumping easier. This relationship may represent some kind of adaptive mechanism. I am not sure that it is directly related but blood transfusion appears detrimental in heart failure, even despite worsened prognosis in anemic patients.