Impact of Anemia on Left Ventricular Reverse Remodeling in Response to Carvedilol

摘要

Anemia is frequently observed in patients with heartfailure (HF) and is associated with high mortalityrates (Figure). Although the mechanisms by whichanemia worsens the prognosis of HF patients are yetunclear, it has been recently reported that anemia correlateswith high cardiac index and low systemic vascular resistanceindex in congestive HF patients.1 The association of anemiawith both cardiac and renal dysfunction is widely recognizedas cardio-renal-anemia syndrome. Recent guidelinerecommendedtherapies, including β-blockers, have loweredthe mortality rate of HF patients with reduced left ventricularejection fraction (HFrEF).2 Beta-blockers decreasesympathetic nervous activity,3 renin secretion, calciumoverload, myocardial oxygen demand, vasoconstriction,fluid retention and oxidative stress, with resultant leftventricular (LV) reverse remodeling, and improvement inthe prognosis of HFrEF patients.2 The effect of β-blockerson an improved prognosis may vary according to thepatient’s clinical background, such as age, baseline heartrate,2 etiology of HF, presence of atrial fibrillation,4 diabetes,5 chronic kidney disease,6 chronic obstructive pulmonarydisease, and peripheral artery disease, among others (Table).