Anemia and its impact on clinical, echocardiographic parameters and prognosis in patients with severe aortic stenosis and normal left ventricular ejection fraction

Introduction: Anemia is common in patients (pts) with severe aortic stenosis (AS). Untreated anemia and severe AS are individually associated with the develop-ment of heart failure, however data regarding the po-tential detrimental effect of anemia on left ventricular (LV) function and prognosis in pts with severe AS are controversial.

Objective: To investigate the impact of anemia on cli-nical status, echocardiographic parameters and pro-gnosis in patients with severe AS and preserved LV ejection fraction (LVEF).

Methods: 264 consecutive patients with severe AS (aortic valve area [AVA] index ≤0.6 cm2/m2) and pre-served LVEF (>50%) referred to our echocardiography laboratory were prospectively enrolled (66 ± 11 yrs, 147 men). All patients underwent complete clinical examination and comprehensive echocardiography, including speckle tracking-derived measurements of LV and left atrial (LA) strain. Baseline clinical variables included NYHA class, cardiac risk factors, haemoglo-bin (Hb) level and glomerular filtration rates (GFR, by MDRD formula). The definition of anemia was based on gender-specific cut-off values, as recommended by the WHO (Hb <13.0 g/dL for men, <12.0 g/dL for wo-men). Patients with more than mild aortic regurgitati-on or mitral valve disease, atrial fibrillation or cardiac pacemakers were excluded.

Results: T he study population included 264 patients (pts) (66 ± 11 yrs, 147 men). Anemia was present in 64 patients (24%). Aortic valve replacement (AVR) was performed in 151 patients. Dividing the study populati-on into 2 groups, according to the presence/absence of anemia, no significant differences were found between groups regarding: age, body surface area, LVEF (62 ± 7 vs. 63 ± 6%), LV Global Longitudinal Strain (-15.2 ± 4 vs. -14.7 ± 3%), LV mass index, mean aortic gradient, indexed AVA (0.40 ± 0.09 vs. 0.39 ± 0.09 cm2/m2) or presence of significant coronary artery disease (p> 0.05 for all). Compared to patients with normal Hb level, in patients with anemia, NYHA class (p=0.03), brain natriuretic peptide values (p=0.004), lateral E/e’(16.2 ± 6.9 vs. 13.7 ± 6.3, p=0.01) and average E/e› ratio (15.9 ± 5.9 vs. 14.1 ± 5.3, p=0.03), LA volume index (54.3 ± 16.9 vs. 45.0 ± 12.1 ml/m2, p<0.001), and systolic pul-monary artery pressure (38 ± 13 vs. 33 ± 8, p=0.009) were all significantly higher. During a 3–years follow-up 47 patients died. Age, NYHA class, BNP serum level, baseline anemia, LA volume index and systolic pulmo-nary pressure were associated with all-cause mortality in the whole study group (p<0.03 for all). In the group of pts who underwent AVR, NYHA class was the only independent predictor of all-cause mortality.

Conclusions: In our study including pts with severe AS and preserved LVEF, patients with baseline anemia presented worse functional status and LV diastolic dys-function and increased 3-year all-cause mortality com-pared to those with normal Hb levels. However, in pts who underwent surgical AVR, there was no impact of baseline anemia on 3-year survival.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)