The prevalence and outcomes of unrecognized left ventricular dysfunction (ULVSD) in patients with anemia and chronic kidney disease (CKD) is not known. The authors determined whether anemia (hemoglobin <13 g/L) and CKD (glomerular filtration rate <60 mL/min) are risk factors for ULVSD (ejection fraction <35%, no known heart failure [HF]) and to determine its impact on clinical outcomes. A total of 1358 patients without history of HF undergoing gated myocardial perfusion single photon emission computed tomography for evaluation of suspected coronary artery disease were followed for a mean of 2.15 ± 0.8 years. End points were death and heart failure hospitalization (HFH). Patients were divided into 4 groups (I: no anemia/no CKD, n=752; II: CKD/no anemia, n=285; III: anemia/no CKD, n=153; IV: anemia+CKD, n=168). Compared with group I, LVSD was significantly more common in group IV (11.3% vs 4%; P=.0009). Death and HFH were significantly higher in group IV compared with group I (death rate for group I: 3.5% per year vs group IV: 12% per year; P<.0001) (HFH rate for group I: 1.5% per year vs group IV: 8% per year, P<.0001). Among patients with ejection fraction <35%, presence of anemia+CKD was associated with a relative risk of 2.48 (95% confidence interval, 1.13-5.4; P=.02) for death compared with group I. Among patients with ULVSD, only 65% were taking angiotensin enzyme inhibitors/angiotensin receptor blockers and β-blockers. ULVSD was almost 3 times more common in patients with anemia+CKD compared with those without and was associated with a significantly higher risk of death and HFH. It may therefore be beneficial to screen patients with anemia and CKD for ULVSD, since early therapy may improve outcomes.
© 2010 Wiley Periodicals, Inc.