European Heart Journal Advance Access originally published online on August 12, 2008
European Heart Journal 2008 29(19):2343-2350; doi:10.1093/eurheartj/ehn359
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Chronic heart failure leads to an expanded plasma volume and pseudoanaemia, but does not lead to a reduction in the body's red cell volume
1 Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
2 Department of Nuclear Medicine, Medical University of Vienna, Vienna, Austria
3 Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Vienna, Vienna, Austria
4 Research Institute for Health Care Management and Economics, Vienna University of Economics and Business Administration, Vienna, Austria
Received 11 February 2008; revised 9 July 2008; accepted 17 July 2008; online publish-ahead-of-print 12 August 2008.
* Corresponding author. Tel: +43 1 40 400 4614, Fax: +43 1 40 400 4216, Email: martin.huelsmann{at}meduniwien.ac.at
Aims: Chronic heart failure (CHF) is frequently associated with a decreased haemoglobin level, whereas the mechanism remains largely unknown.
Methods and results: One hundred consecutive CHF patients without anaemia or renal dysfunction based on non-cardiac reasons were enrolled. We explored determinants of anaemia (as iron parameters, erythropoietin, hepcidin and kidney function) including red cell volume (RCV) (by a 51 Cr assay) as well as related markers and plasma volume. The influence of each factor on haemoglobin concentrations was determined in a multiple regression model. Mean haemoglobin concentrations were 11.7 ± 0.8 mg/dL in anaemic CHF patients and 14.4 ± 1.2 mg/dL in non-anaemic patients. Corrected reticulocytes were lower in anaemic patients (35.1 ± 15.7 vs. 50.3 ± 19.2 G/L, P = 0.001), but the RCV was not reduced (1659.3 ± 517.6 vs. 1826.4 ± 641.3 mL, P = 0.194). We found that plasma volumes were significantly higher in anaemic CHF patients (70.0 ± 2.4 vs. 65.0 ± 4.0%, P < 0.001). Plasma volume was the best predictor of haemoglobin concentrations in the regression model applied (B = –0.651, P < 0.001, R2 = 0.769).
Conclusion: Haemodilution appears to be the most potent factor for the development of low haemoglobin levels in patients with CHF. Our data support an additional independent, but minor influence of iron deficiency on haemoglobin concentrations in CHF patients.
Key Words: Anaemia • Heart failure • Erythropoietin • Plasma volume • Hepcidin • Haemodilution
C.A. and S.K. contributed equally.
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