CLINICAL FEATURES OF HEART FAILURE WITH LOW EJECTION FRACTION COMBINED WITH ANEMIA

Introduction. In patients with chronic heart failure (CHF), anemia is more common than in the general population, and its prevalence, according to various authors, ranges from 15 to 61%. Decreased hemoglobin levels are an independent factor contributing to mortality in this cohort. According to a retrospective analysis of the Val-HeFT study, patients with CHF with a decrease in hemoglobin during 12 months of follow-up had a higher rate of readmissions, complications and death compared with patients without a decrease in hemoglobin (Hb).

The aim of our work was to study the clinical features and laboratory and instrumental manifestations in patients with CHF with low ejection fraction (CHFrEF) and anemia.

Material and methods. We conducted a continuous sample and analyzed 105 case histories of patients for 2022, who were admitted with CHFlEF (EF < 40%) to the cardiology department of the City Clinical Hospital No. 3. The functional class (FC) of CHF was established according to the scale for assessing the clinical condition in CHF (SHOKS, modified by Mareeva V.Yu., 2000), stage - according to the Strazhesko-Vasilenko classification. The edematous syndrome was assessed by points (1 - feet, 2 - lower leg, 3 - scrotum / inguinal region, 4 - abdomen, 5 - chest wall). The presence of anemia was determined by the level of Hb: <130 g/l for men, <120 g/l for women. All patients underwent Holter monitoring of the electrocardiogram (HM ECG) and echocardiography (EchoCG). The indicators of patients with CHFrEF with and without anemia were studied and compared. For this purpose, the Mann–Whitney, Wilcoxon, and c2 tests were used for nonparametric data. The Statistica 12.0 software package (Statsoft, USA) was used.

Results. The general group of patients with CHFrEF included 72.4% of men (n=76) and 27.6% of women (n=29), mean age 66.9±12.3. Of these, anemia was detected in 25.7% of cases (n=27), the proportion of men was 66.7% (n=18, mean age 69.1±9.4), women - 33.3% (n=9 , mean age 68.9±16.7). The mean age of patients with CHFrEF in the group with and without anemia did not differ significantly (69.0±12.0 and 66.1±12.3, respectively, р˃0.05). In patients with CHFrEF and anemia, hemoglobin values were significantly lower (106.9±12.7 and 151.6±15.8 g/l, respectively, p<0.001), mean hemoglobin content in erythrocytes (29.1±13, 2 and 31.2±7.7 pg, respectively, p<0.001), the number of erythrocytes (4.2±1.0 and 5.0±0.6 1012/l, respectively, p<0.001), serum iron ( 9.9±9.6 and 10.4±4.1 µmol/l, respectively, p<0.001), erythrocyte sedimentation rate (ESR) (20.9±13.7 and 8.8±8.8 mm/ hour, respectively, p<0.001). Patients with anemia had lower FC (10.3±2.2 and 8.9±2.7 points, respectively, p=0.022) and CHF stage (IIa - 19%, IIB - III - 81% versus IIa - 57 %, IIB - III - 43%, respectively, p=0.02), more pronounced edematous syndrome (2.3±1.0 and 1.8±1.1 points, respectively, p=0.039). According to HM ECG data, patients with anemia had a greater number of ventricular extrasystoles (3445.4±4439 versus 1727.4±3059.0, respectively, p=0.05). EchoCG parameters did not differ in both groups.

Conclusion. Every fourth patient with CHFrEF has anemia, while there are no significant differences in age and gender. The combination of CHFrEF with anemia significantly aggravates the course of CHF (according to SHOKS, stage of CHF, severity of edematous syndrome).