Anemia from the perspective of the problem of chronic heart failure: pathogenesis and laboratory diagnosis
Analyzing the data of the contemporary world literature, this paper presents the main points regarding etiological factors and pathogenesis of the contraction of anemia in patients with chronic heart failure. The literature data on the present state of the problem of anemia of iron deficiency genesis, epidemiology and the relation of iron metabolism to various factors have been provided. The attention has been focused on the necessity and, at the same time, the complexity and the features of the diagnosis of absolute and functional iron deficiency in the event of chronic heart failure.
Aim. To analyze the contemporary views on the etiopathogenesis of anemia of iron deficiency genesis and their impact on the course of chronic heart failure and the quality of patients' life, as well as to generalize the main laboratory and diagnostic criteria of iron deficiency anemia and anemia of chronic diseases in patients with chronic heart failure according to the most recent studies and standards of hematological indicators.
Material and Methods. The analysis and generalization of the results of current research devoted to the study of anemia as a new therapeutic target in the event of chronic heart failure, have been carried out. Forty literary primary sources, revealing contemporary views on this problem in more detail, have been selected.
Results and Discussion. Chronic heart failure is characterized by a progressive growth rate in the population and remains an urgent problem of our time. The combination of chronic heart failure with other comorbid states, which can significantly complicate its course, attracts great attention of the researchers. More and more sources appear indicating the high incidence of anemia as of a clinical and hematological syndrome among patients with cardiovascular diseases. From this perspective, the combination of chronic heart failure with anemia appears to be quite problematic from the practical point of view. The role of anemia as of an independent risk factor in the event of chronic heart failure has been studied in a large number of studies. It has been proven that anemia has an adverse impact on the clinical prognosis of patients with chronic heart failure, decreases functional ability and quality of patients' life, increases the number of hospital admissions , the progression of remodeling of left ventricle myocardium and the emergence of resistance to standard treatment, and increases general and cardiovascular mortality. The prevalence of anemiae among patients with chronic heart failure, according to various data, has sufficiently large discrepancies, which are explained by previously unavailable single approach to the diagnosis of anemia. However, according to recent studies, precise diagnostic criteria, offering an opportunity to differentiate different types of anemic syndromes of iron deficiency genesis, have been approved. Correspondingly, an accurate assessment of the genesis of anemia is required for choosing the right approach to its correction.
Conclusions. Patients with chronic heart failure and anemia persent a particular problem for practical healthcare. An adverse impact of anemia on the course of chronic heart failure has been proven. The correction of anemic syndrome is of great importance for effective treatment of chronic heart failure. For this purpose, it is essential to define the pathophysiological variant of anemia, which directly determines the effectiveness of the correction. Among various variants of anemia in the event of chronic heart failure, the most frequent ones are iron deficiency anemia and anemia of chronic diseases or their combination. Nowadays, specific laboratory criteria for differential diagnosis of various variants of anemia in this category of patients have been defined.
Ageev F.T., Belenkov Y.V., Fomin I.V. et al. Prevalence of chronic cardiac failure in the European part of the Russian Federation - data the ERA - HSN. Serdechnaya nedostatochnost 2006; 3: 112-115.
Amosova Ye.N., Sidorova L.L., Tsaralunga V.N. Functional state of cardiovascular system in patients with chronic heart failure of coronary genesis and concomitant iron deficiency anemia. Serce i sudyny 2011; 3: 71-80.
Amosova Ye.N., Tsaralunga V.N. Assessment of severity and clinical significance of iron deficiency in patients with chronic heart failure and left ventricular ejection fraction more than 40% with probable unreasonable iron deficiency anemia and without anemia. Serce i sudyny 2015; 4: 47-56.
Anand I.S. Anemia and chronic heart failure implications and treatment options. J Am Coll Cardiol 2008, 52 (7), 501-511. https://doi.org/10.1016/j.jacc.2008.04.044
Anker S.D. Rationale and design of Finject Assessment in patients with chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anemia. Eur J Heart Fail 2009, 11 (11), 1084-1091. https://doi.org/10.1093/eurjhf/hfp140
Boiko T.Y., Yehorova S.Yu., Paranko H.S. et al. Ferrokinetic Parameters and Regulation of Iron Metabolism in Patients with Chronic Inflammatory Bowel Diseases. Hastroenterologia 2014; 4: 110-116.
Brasse-Lagnel C., Karim Z., Letteron P., Bekri S., Bado A., Beaumont C. Intestinal DMT1 cotransporter is down-regulated by hepcidin via proteasome internalization and degradation. Gastroenterology 2011, 140 (4), 1261-1271. https://doi.org/10.1053/j.gastro.2010.12.037
Cartwright G.E. The anemia of chronic disorders. Semin Hematol. 1966, 3 (4), 351-375.
Cazzola M., Ponchio L., de Benedetti F, Ravelli A, Rosti V, Beguin Y, Invernizzi R, Barosi G, Martini A. Defective iron supply for erythropoiesis and adequate endogenous erythropoietin production in the anemia associated with systemic-onset juvenile chronic arthritis. Blood. 1996, 87 (11), 4824-4830.
Chan F.K.L., Ching J.V.L., Hung L.C.T. Clopidogrel versus aspirin and esomeprazole to prevent recurrent ulcer bleeding. N Engl J Med 2005, 352, 238-244. https://doi.org/10.1056/NEJMoa042087
Chasis J.A., Mohandas N. Erythroblastic islands: niches for erythropoiesis. Blood. 2008, 112 (30, 470-478.
Cullis J.O. Diagnosis and management of anaemia of chronic disease: current status. Br J Haematol 2011, 154 (3), 289-300. https://doi.org/10.1111/j.1365-2141.2011.08741.x
Dallman P.R., Yip R., Johnson C. Prevalence and causes of anemia in the United States, 1976 to 1980. Am J Clin Nutr 1984, 39 (3), 437-445. https://doi.org/10.1093/ajcn/39.3.437
Demirag M.D., Haznedaroglu S., Sancak B., Konca C., Gulbahar O., Ozturk M.A., Goker B. Circulating hepcidin in the crossroads of anemia and inflammation associated with rheumatoid arthritis. Intern Med 2009, 48 (6), 421-426. https://doi.org/10.2169/internalmedicine.48.1578
Dyadyk A.I. Congestive heart failurein modern clinicalpractice A.I. Dyadyk, A.E. Bagriy. Donetsk.: KP Region, 2005. 549 p.
Dziak G.V. Anaemia it is a comorbid state G.V. Dziak, T. O. Pertseva, V. A. Potabashnii et al. Donetsk.: IMA-press, 2013. 268 p.
Ebner N., von Haehling S. Iron Deficiency in Heart Failure: A Practical Guide. Nutrients 2013, 5 (9), 3730-3739. https://doi.org/10.3390/nu5093730
Fadeenko G.D. Iron deficiency anemiain the gastrointestinal tract pathology: a notefor the physician and gastroenterologist. Zdorovia Ukrainy XXI storichchia 2007; 4: 60-61.
Faquin W.C., Schneider T.J., Goldberg M.A. Effect of inflammatory cytokines on hypoxia-induced erythropoietin production. Blood 1992, 79 (8), 1987-1994.
Ivanov V.P., Kolesnik M.O., Kolesnik O.M. et al. Course peculiarities of chronic heart failure with comorbid iron deficiency, clinical-prognostic significance of iron deficiency correction. Kardyolohyia: ot nauky k praktyke 2015; 3 (16): 61-85.
Khrutskaya M.S. Clinical pathogenic aspects of anemia syndrome in patients with chronic heart failure. Medytsynskyi zhurnal 2014; 3: 134-138.
Knyazkova I.I. Current approaches to diagnosisof anemia. Liky Ukrainy, 2010; 7: 52-56.
Malkoch A.V., Anastasevich L.A., Filatova N.N. Irondeficiency and iron deficiency anemia among women of childbearing age. Reproduktivnaya endokrinologiya 2013; 5: 22-27. https://doi.org/10.18370/2309-4117.2013.13.22-27
Miller C.B., Jones R.J., Piantadosi S. Abeloff M.D, Spivak J.L. Decreased erythropoietin response in patients with the anemia of cancer. N Engl J Med 1990, 322 (24), 1689-1692. https://doi.org/10.1056/NEJM199006143222401
Nemeth E., Tuttle M. S., Powelson J., Vaughn M. B., Donovan A., Ward D. M., Ganz T., Kaplan J. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization. Science 2004, 306 (5704), 2090-2093. https://doi.org/10.1126/science.1104742
Okonko D.O., Grzeslo A., Witkowski T., Mandal A.K., Slater R.M., Roughton M., Foldes G., Thum T., Majda J., Banasiak W., Missouris C.G., Poole-Wilson P.A., Anker S.D., Ponikowski P. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol 2008, 51 (2), 103-112. https://doi.org/10.1016/j.jacc.2007.09.036
Palazzuoli A., Gallotta M., Iovine F., Nuti R., Silverberg D. S. Anaemia in heart failure: a common interaction with renal insufficiency called the cardio-renal anaemia syndrome. Int J Clin Pract 2008, 62 (2), 281-286. https://doi.org/10.1111/j.1742-1241.2007.01650.x
Scherbinina S.P., Romanova E.A., Levina A.A. et al. Diagnostic value of a complex study of iron metabolism in clinical practice. Hematology and Transfusiology 2005; 5: 23-28.
Siller-Matula J. M., Huber K., Christ G., Schr?r K., Kubica J., Herkner H., Jilma B. Impact of clopidogrel loading dose on clinical outcome in patients undergoing percutaneous coronary intervention: a systematic review and meta-analysis. Heart 2011, 92 (2), 98-105. https://doi.org/10.1136/hrt.2010.195438
Silverberg D.S., Wexler D., Schwartz D. Is Correction of Iron Deficiency a New Addition to the Treatment of the Heart Failure? Int J Mol Sci 2015, 16 (6), 14056-14074. https://doi.org/10.3390/ijms160614056
Stuklov N.I. Iron Deficiency and Anemia in Patients with Chronic Heart Failure. Rational Pharmacotherapy in Cardiology 2017;13(5): 651-660. https://doi.org/10.20996/1819-6446-2017-13-5-651-660
Sumarokov A.B., Buryachkovskaya L.I., Uchitel I.A. Bleeding in patients with coronary heart disease during antiplatelet therapy. CardioSomatika 2011; 3: 29-35.
Tee Joo Yeo, Poh Shuan Daniel Yeo, Raymond Ching-Chiew Wong. Iron deficiency in a multi-ethnic Asian population with and without heart failure: prevalence, clinical correlates, functional significance and prognosis. Eur J Heart Fail 2014, 16, 1125-1132. https://doi.org/10.1002/ejhf.161
Tereshchenko S.N., Atroshchenko E.S., Uskach T.M. et al. Anemia as complication of chronic heart failure: prevalence, treatment, prognosis. Ter Arkh. 2008; 9: 90-95.
Tikhomirov, A.L., Sarsania, S.I., Nochevkin, E.V. Some aspects of diagnostics and treatment of iron deficiency states in practice at the present stage. Difficult Patient 2011; 11: 26-38.
Usman M.H., Notaro I., Nagarakanty D.J., Brahin E., Dessain S., Gracely E., Ezekowitz M.D. Combination antiplatelet therapy for secondary stroke prevention: enhanced efficacy or double trouble? Am J Cardiol 2009, 103 (8), 1107-1112. https://doi.org/10.1016/j.amjcard.2009.01.003
Voronkov L.G. Anemia in a patient with CHF: how to evaluate and how to treat? Sertseva nedostatnist 2015; 2: 5-14.
Voronkov L.G., Amosova K.M., Dziak G.V. et al. Guidelines of the Ukrainian Association of Cardiology of the diagnosis and treatment of chronic heart failure (2017) (Special Issue). Heart Failure and Comorbidities 2017; 1 (Annex 1): 67 p.
This work is licensed under a Creative Commons Attribution 4.0 International License.