International Journal of Medical Sciences

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23 October 2017

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Int J Med Sci 2015; 12(8):618-624. doi:10.7150/ijms.11924

Research Paper

Anemia as an Independent Predictor of Adverse Cardiac Outcomes in Patients with Atrial Fibrillation

Wen-Hsien Lee1,2,3, Po-Chao Hsu1,3, Chun-Yuan Chu1, Hung-Hao Lee1, Meng-Kuang Lee1,2, Chee-Siong Lee1,3, Hsueh-Wei Yen1,3, Tsung-Hsien Lin1,3, Wen-Chol Voon1,3, Wen-Ter Lai1,3, Sheng-Hsiung Sheu1,3, Ho-Ming Su1,2,3✉

1. Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
2. Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
3. Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

Abstract

Background: Anemia and echocardiographic systolic and diastolic parameters are useful predictors of cardiovascular outcomes in patients with atrial fibrillation (AF). However, no studies have evaluated the use of anemia for predicting cardiovascular outcome in AF patients when the important echocardiographic parameters are known. Therefore, this study was designed to evaluate whether low hemoglobin is a useful parameter for predicting poor cardiac outcome after adjustment for important echocardiographic parameters in AF patients.

Methods: Index beat method was used to measure echocardiographic parameters in 166 patients with persistent AF. Cardiac events were defined as death and hospitalization for heart failure. The association of hemoglobin with adverse cardiac events was assessed by Cox proportional hazards model.

Results: The 49 cardiac events identified in this population included 21 deaths and 28 hospitalizations for heart failure during an average follow-up of 20 months (25th-75th percentile: 14-32 months). Multivariable analysis showed that increased left ventricular mass index (LVMI) and decreased body mass index, estimated glomerular filtration rate, and hemoglobin (hazard ratio 0.827; P = 0.015) were independently associated with increased cardiac events. Additionally, tests of a Cox model that included important clinic variables, LVMI, left ventricular ejection fraction, and the ratio of transmitral E-wave velocity to early diastolic mitral annulus velocity showed that including hemoglobin significantly increased value in predicting adverse cardiac events (P = 0.010).

Conclusions: Hemoglobin is a useful parameter for predicting adverse cardiac events, and including hemoglobin may improve the prognostic prediction of conventional clinical and echocardiographic parameters in patients with AF.

Keywords: Hemoglobin, anemia, atrial fibrillation, cardiac outcomes.

This is an open access article distributed under the terms of the Creative Commons Attribution (CC BY-NC) License. See http://ivyspring.com/terms for full terms and conditions.
How to cite this article:
Lee WH, Hsu PC, Chu CY, Lee HH, Lee MK, Lee CS, Yen HW, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Anemia as an Independent Predictor of Adverse Cardiac Outcomes in Patients with Atrial Fibrillation. Int J Med Sci 2015; 12(8):618-624. doi:10.7150/ijms.11924. Available from http://www.medsci.org/v12p0618.htm