Anemia Negatively Impacts Right Ventricular Function in Patients with HFpEF

Anemia in heart failure with preserved ejection fraction (HFpEF) is linked to a notable decline in right ventricular function, irrespective of classical risk factors, including smoking, hypertension, and diabetes, as well as sex and age, according to new research.¹

This retrospective analysis evaluated the electronic medical record data of more than 1000 patients with HFpEF in a department of cardiovascular medicine in China. Overall, the degree of anemia in this patient population with HFpEF was significantly negatively correlated with right ventricular function.

“Based on these results, we speculated that impaired right ventricular function may be one of the important mechanisms by which anemia contributes to worsening heart failure,” wrote the investigative team, led by Jie Wang, emergency department, Wangjing Hospital of China Academy of Chinese Medical Sciences.

Further insight into the development of right ventricular dysfunction is expected to benefit disease knowledge and allow for better treatments to improve patient outcomes including in heart failure.² Management of comorbidities in heart failure can impact the clinical course, with anemia frequent comorbidity linked to a poorer prognosis.

Most available literature reported on the link between anemia and left ventricular dysfunction, making studies on the link between anemia and right ventricular impairment rare.³ In the current analysis, Wang and colleagues assessed the relationship between anemia and right ventricular function in HFpEF to determine the possible mechanisms and provide a new target for optimal secondary prevention.¹

The investigative team retrospectively evaluated 1014 patients with HF, who demonstrated history, signs, symptoms, and treatment for HFpEF. Diagnostic criteria for HFpEF included the presence of Framingham criteria-defined heart failure, left ventricular ejection fraction (LVEF) ≥50%, and NT-proBNP >125 pg/mL. After exclusions, the final cohort involved 388 patients with HFpEF.

For the analysis, univariate and multivariate linear regression analysis determined predictors of the tricuspid annular plane systolic excursion (TAPSE)/pulmonary arterial systolic pressure (PASP) index. Age and sex were further evaluated in multiple linear regression analysis.

Demographic data showed the patient population had an average age of 75.7 years and 158 (40.7%) were men. Patients with anemia (n = 215) were older and had a significantly higher New York Heart Association (NYHA) functional class and degree of tricuspid regurgitation (TR) than non-anemic patients.

Upon analysis, hemoglobin levels had a weak negative linear correlation with NT-pro-BNP (r = 0.30; P <.0001) and a positive correlation with the TAPSE-PASP ratio (r = 0.44; P <.0001). Multivariate linear regression analysis found the degree of anemia and atrial fibrillation were independently linked to the TAPSE/SPAP ratio.

However, the effect modification by sex or age on the association between the degree of anemia and the TAPSE/SPAP ratio was not statistically significant (P >.05), according to Wang and colleagues.

“Our study shows that the degree of anemia is an independent predictor of the TAPSE/PASP ratio, suggesting that the degree of anemia shows a modest correlation with right ventricular function, as indicated by the TAPSE/PAPS ratio, with right ventricular function tending to decrease as anemia severity increases,” they added. “Theoretically, the relationship between anemia and right ventricular dysfunction may be multifaceted.”

References

1. _{Wang J, Jiang J, Li X, et al. Right ventricular function and anemia in heart failure with preserved ejection fraction. Front Cardiovasc Med. 2024;11:1424576. Published 2024 Nov 18. doi:10.3389/fcvm.2024.1424576}
2. _{Ambrosy AP, Gurwitz JH, Tabada GH, et al. Incident anaemia in older adults with heart failure: rate, aetiology, and association with outcomes. Eur Heart J Qual Care Clin Outcomes. 2019;5(4):361-369. doi:10.1093/ehjqcco/qcz010}
3. _{Cho IJ, Mun YC, Kwon KH, Shin GJ. Effect of anemia correction on left ventricular structure and filling pressure in anemic patients without overt heart disease. Korean J Intern Med. 2014;29(4):445-453. doi:10.3904/kjim.2014.29.4.445}