Contributions of anemia to exercise intolerance in heart failure with preserved ejection fraction-An exercise stress echocardiographic study

被引：5

作者：

Naito, Ayami ^{[1
,2
]}

Obokata, Masaru ^{[1
]}

Kagami, Kazuki ^{[1
,2
]}

Harada, Tomonari ^{[1
]}

Sorimachi, Hidemi ^{[1
]}

Yuasa, Naoki ^{[1
]}

Saito, Yuki ^{[1
,3
]}

Kato, Toshimitsu ^{[1
]}

Wada, Naoki ^{[4
]}

Adachi, Takeshi ^{[2
]}

Ishii, Hideki ^{[1
]}

机构：

[1] Gunma Univ, Grad Sch Med, Dept Cardiovasc Med, 3-39-22 Showa Machi, Maebashi, Gunma 3718511, Japan

[2] Natl Def Med Coll, Div Cardiovasc Med, Tokorozawa, Saitama, Japan

[3] Nihon Univ, Sch Med, Dept Med, Div Cardiol, Tokyo, Japan

[4] Gunma Univ, Grad Sch Med, Dept Rehabil Med, Maebashi, Gunma, Japan

来源：

IJC HEART & VASCULATURE | 2023年 / 48卷

关键词：

Exercise capacity; Heart failure with preserved ejection fraction; Anemia; MECHANISMS; MORTALITY; RESERVE;

D O I：

10.1016/j.ijcha.2023.101255

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Aims: Anemia is common in patients with heart failure with preserved ejection fraction (HFpEF) and is associated with exercise intolerance. However, there are limited data on how anemia contributes to reduced exercise capacity in patients with HFpEF. We aimed to characterize exercise capacity, cardiovascular and ventilatory reserve, and the oxygen (O2) pathway in anemic patients with HFpEF.Methods: A total of 238 patients with HFpEF and 248 dyspneic patients without HF underwent ergometry exercise stress echocardiography with simultaneous expired gas analysis. Patients with HFpEF were classified into two groups based on the presence of anemia (hemoglobin < 13.0 g/dL in men and < 12.0 g/dL in women).Results: Anemic HFpEF patients (n = 112) had worse nutritional status and renal function, lower iron levels, and greater left ventricular (LV) remodeling and plasma volume expansion than those without anemia (n = 126). Exercise capacity, assessed by peak oxygen consumption, exercise intensity, and exercise duration, was lower in the anemic HFpEF group than in the other groups. Despite a similar cardiac output during exercise, anemic patients with HFpEF demonstrated limitations in arterial O-2 delivery, lower arteriovenous O-2 content difference, and ventilatory inefficiency (higher minute ventilation vs. carbon dioxide production slope) during peak exercise.Conclusion: Anemic HFpEF patients demonstrated unique pathophysiological features with greater LV remodeling and plasma volume expansion, limitations in arterial O2 delivery and peripheral O-2 extraction, and ventilatory inefficiency, which may contribute to reduced exercise capacity. Further studies are needed to develop an optimal approach for treating anemia in patients with HFpEF.

引用

页数：7

共 36 条

[1]

ANAND IS, 1993, BRIT HEART J, V70, P357

[2] Impact of Noncardiac Comorbidities on Morbidity and Mortality in a Predominantly Male Population With Heart Failure and Preserved Versus Reduced Ejection Fraction [J].