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CLINICAL RESEARCH: HEART FAILURE

Prognostic value of plasma erythropoietin on mortality in patients with chronic heart failure

Peter van der Meer, MD^*,*, Adriaan A. Voors, MD^*, Erik Lipsic, MD^*, Tom D. J. Smilde, MD^*, Wiek H. van Gilst, PhD and Dirk J. van Veldhuisen, MD, FACC^*

^* Department of Cardiology, University Hospital Groningen, Groningen, the Netherlands
Department of Clinical Pharmacology, University of Groningen, Groningen, the Netherlands

Manuscript received December 9, 2003; revised manuscript received February 20, 2004, accepted March 16, 2004.

^* Reprint requests and correspondence: Dr. Peter van der Meer, Hanzeplein 1, 9700 RB Groningen, the Netherlands.
p.van.der.meer{at}thorax.azg.nl

OBJECTIVES: This study aimed to investigate the prognostic importance of plasma erythropoietin (EPO) levels in chronic heart failure (CHF) patients.

BACKGROUND: Anemia is common and is associated with an impaired survival in patients with CHF. Erythropoietin is a hematopoietic growth factor, upregulated in anemic conditions. Little is known about the pathophysiology of anemia in CHF and the prognostic importance of plasma EPO levels in CHF patients.

METHODS: In 74 patients with CHF (age, 61 ± 2 years; left ventricular ejection fraction, 0.31 ± 0.01; peak oxygen consumption, 19.1 ± 0.6 [mean ± SEM]) and in 15 control patients, hemoglobin levels and plasma concentrations of EPO and brain natriuretic peptide were measured.

RESULTS: During a mean follow-up of 3.0 years (range, 2.3 to 5.3 years), 22 patients (30%) died. Anemia was present in 24% of the patients. Multivariate analysis showed that plasma EPO (p = 0.026) and hemoglobin levels (p = 0.005) were independent predictors of survival in this CHF population. We observed only a mild inverse correlation between the logarithm of EPO and hemoglobin levels (r² = 0.08, p = 0.02) in CHF patients, whereas the control group showed a clear significant inverse correlation (r² = 0.44, p = 0.007).

CONCLUSIONS: Elevated plasma EPO levels are associated with an impaired prognosis independent of hemoglobin levels and other established markers of CHF severity. Furthermore, in the CHF patients, EPO levels poorly correlate with the hemoglobin levels, in contrast with the control group.

Abbreviations and Acronyms   BNP = brain natriuretic peptide   CHF = chronic heart failure   CI = confidence interval   EPO = erythropoietin   GFR = glomerular filtration rate   Hb = hemoglobin   HR = hazard ratio   LV = left ventricular   LVEF = left ventricular ejection fraction   NYHA = New York Heart Association

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