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European Heart Journal Advance Access originally published online on June 29, 2005
European Heart Journal 2005 26(21):2232-2237; doi:10.1093/eurheartj/ehi388
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure

Cristina Opasich1,*, Mario Cazzola2, Laura Scelsi3, Stefania De Feo1, Enzo Bosimini4, Rocco Lagioia5, Oreste Febo6, Roberto Ferrari7, Alessandro Fucili7, Remigio Moratti8, Roberto Tramarin1 and Luigi Tavazzi3

1Department of Cardiology, Institute of Pavia, IRCCS Fondazione Salvatore Maugeri, Strada Ferrata 8, 27100 Pavia, Italy
2Division of Haematology, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
3Division of Cardiology, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy
4Department of Cardiology, Institute of Veruno, IRCCS Fondazione Salvatore Maugeri, Veruno, Italy
5Department of Cardiology, Institute of Cassano Murge, IRCCS Fondazione Salvatore Maugeri, Cassano Murge, Italy
6Department of Cardiology, Institute of Montescano, IRCCS Fondazione Salvatore Maugeri, Montescano, Italy
7Department of Cardiology, University of Ferrara, Ferrara, Italy
8Laboratory of Chemical Analysis, IRCCS Policlinico S. Matteo, University of Pavia, Pavia, Italy

Received 11 December 2004; revised 28 March 2005; accepted 2 June 2005; online publish-ahead-of-print 29 June 2005.

* Corresponding author. Tel: +39 0382 592604; fax: +39 0382 592900. E-mail address: copasich{at}fsm.it

See page 2213 for the editorial comment on this article (doi:10.1093/eurheartj/ehi509)

Aims Anaemia is often observed in patients with chronic heart failure (CHF), and it may be associated with a worse prognosis. Aim of this study was to identify the individual mechanisms of anaemia in CHF patients.

Methods and results One hundred and forty-eight consecutive patients with haemoglobin concentration <13 g/dL (if males) or <12 g/dL (if females) were enrolled. Factors responsible for anaemia were investigated by evaluating endogenous erythropoietin (Epo) production, serum cytokines levels, body iron status, and iron supply for erythropoiesis. Most patients (57%) presented anaemia of chronic disease and among them, 92% showed evidence of a defective endogenous Epo production. This was indicated by an observed/predicted log(serum Epo) ratio less than 0.8 and/or a defective iron supply for erythropoiesis diagnosed by low transferrin saturation and/or increased value of soluble transferrin receptor. According to regression analysis sex, renal failure, and serum Epo were correlated with anaemia.

Conclusion According to our study, about half of anaemic CHF patients showed anaemia of chronic disease with blunted endogenous Epo production and/or a defective iron supply for erythropoiesis. Determination of the individual mechanisms of anaemia in CHF could justify a rational therapeutic approach to anaemia.

Key Words: Chronic heart failure • Anaemia • Cytokines


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