Epoetin alfa's effect on left ventricular hypertrophy and subsequent mortality

Michael Jones, Brad Schenkel, Julie Just

    Research output: Contribution to journalArticlepeer-review

    17 Citations (Scopus)

    Abstract

    BACKGROUND: Improving anemia in patients with chronic renal failure (CRF) and congestive heart failure (CHF) also improves left ventricular hypertrophy (LVH). No previous meta-analyses have been conducted to further examine this association, including the association between LVH and mortality in these patients.

    METHODS AND RESULTS: Literature searches on MEDLINE, EMBASE, and OVID were performed using Cochrane Library protocols. Two hundred sixteen abstracts were reviewed preliminarily for inclusion in the meta-analysis of epoetin alfa, anemia and 5 pre-selected parameters of LVH. One hundred seventy-nine abstracts were reviewed for LVH and mortality. The predominant hematologic and left ventricular function changes observed during epoetin alfa treatment in patients with CHF and CRF are (1) increases in hemoglobin (Hb) and hematocrit (Hct); (2) decreases in left ventricular mass (LVM) and LVM index; (3) increase in ejection fraction (EF); and (4) decreases in left ventricular end-diastolic and end-systolic volume. Three independent factors-target Hb, duration of disease, and duration of follow-up-each had a statistically significant association with Hb, Hct, and EF, respectively. A separate meta-analysis using 3 risk models showed LVH is strongly and positively associated with both cardiovascular and all-cause mortality, with two- to three-fold increases in risk.

    CONCLUSIONS: LVH is common in patients with CRF and CHF. Current findings indicate epoetin alfa therapy results in anemia amelioration, as evidenced by higher Hb and Hct levels, and reduction of key LVH parameters. LVM regression is associated with lower incidence of cardiovascular-related morbidity and mortality, therefore epoetin alfa therapy may provide a survival benefit.

    Original languageEnglish
    Pages (from-to)253-265
    Number of pages13
    JournalInternational Journal of Cardiology
    Volume100
    Issue number2
    DOIs
    Publication statusPublished - 20 Apr 2005

    Keywords

    • Adult
    • Anemia
    • Epoetin Alfa
    • Erythropoietin
    • Female
    • Heart Failure
    • Hematinics
    • Hemoglobins
    • Humans
    • Hypertrophy, Left Ventricular
    • Kidney Failure, Chronic
    • Male
    • Middle Aged
    • Recombinant Proteins
    • Regression Analysis
    • Ventricular Function, Left
    • Journal Article
    • Meta-Analysis
    • Research Support, Non-U.S. Gov't
    • Review

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