European Heart Journal Advance Access originally published online on May 21, 2008
European Heart Journal 2008 29(12):1510-1515; doi:10.1093/eurheartj/ehn205
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Adequacy of endogenous erythropoietin levels and mortality in anaemic heart failure patients
1 Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
2 Division of Cardiology and Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Charles River Plaza, 185 Cambridgestreet, Simches Building, 3rd Floor, Boston, MA 02114, USA
3 Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
Received 19 November 2007; revised 26 March 2008; accepted 24 April 2008; online publish-ahead-of-print 21 May 2008.
* Corresponding author. Tel: +1 617 643 3441, Email: pvandermeer{at}partners.org or p_van_der_meer{at}hotmail.com
See page 1481 for the editorial comment on this article (doi:10.1093/eurheartj/ehn229)
Aims: We examined the adequacy of endogenous erythropoietin (EPO) levels for the degree of anaemia in patients with chronic heart failure (CHF) and its relation to prognosis.
Methods and results: We studied 74 anaemic CHF patients from a cohort of 240 patients. The adequacy of endogenous EPO levels was assessed by derived observed/predicted (O/P) ratio. A ratio value <0.92 indicates EPO levels lower than expected, whereas a value >1.09 indicates EPO levels higher than expected. The primary endpoint was mortality. During a median follow up of 4.9 years, 35 of the 74 (47.3%) anaemic patients died. EPO levels lower than expected were observed in 29 patients (39%), whereas EPO levels higher than expected were present in 22 anaemic patients (29%). The Kaplan–Meier analysis revealed that anaemic patients with EPO levels higher than expected had a significantly higher mortality rate compared to patients with EPO levels as expected or EPO levels lower than expected (log-rank: P = 0.024). A higher O/P ratio was an independent predictor of increased mortality risk adjusted for variables including age, sex, haemoglobin, NT-proBNP, and renal function; hazard ratio (HR): 1.020 95%CI (1.004–1.036), P = 0.012.
Conclusion: EPO levels higher than expected, suggesting resistance to the hormone, are common in CHF patients and are associated with a higher mortality.
Key Words: Heart failure • Anaemia • Erythropoietin • Prognosis
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