Patients of HFpEF and anaemia may have exercise intolerance and lower exercise capacity

Heart failure with preserved ejection fraction (HFpEF) is becoming more common. This condition is primarily manifested as exercise intolerance. Multiple factors contribute to reduced exercise capacity in HFpEF, including anemia, which is common in these patients and associated with poor outcomes. Various factors can cause anaemia in HFpEF, but the link between anaemia and exercise intolerance in this condition is poorly understood.

According to a study published in the International Journal of Cardiology Heart & Vasculature, HFpEF patients with anaemia showed signs of greater LV remodelling, plasma volume expansion, limitations in arterial O2 delivery and peripheral O2 extraction, and ventilatory inefficiency, leading to reduced exercise capacity. Further research is necessary to devise an effective treatment strategy for anaemic HFpEF patients.

Two hundred thirty-eight patients with HFpEF and 248 dyspneic patients without HF underwent ergometry exercise stress echocardiography with simultaneous expired gas analysis. HFpEF patients were classified into two groups based on anaemia (haemoglobin < 13.0 g/dL for men and < 12.0 g/dL for women.

There needs to be the availability of more data on how anaemia contributes to reduced exercise capacity in HFpEF. This background was further investigated in this study.

Key findings from this study are:

• Compared to those without anaemia, 112 Anemic HFpEF patients had worse nutritional status and renal function, lower iron levels, and greater left ventricular (LV) remodelling and plasma volume expansion than those without anaemia.
• In the anaemic HFpEF group, there was lower exercise capacity, assessed by peak oxygen consumption, exercise intensity, and exercise duration, compared to the other groups.
• Anaemic patients with HFpEF had limitations in arterial O2 delivery, lower arteriovenous O2 content difference, and ventilatory inefficiency during peak exercise.

They said, “The results of our study encourage the screening assessment of anaemia in patients with HFpEF. This can provide insights into the causes of exercise intolerance.”

Study limitations are selection and referral bias, and the sample size was small. Patients with HFpEF were carefully identified, but some may have been missed. Control participants had shortness of breath, poor exercise capacity, and multiple comorbidities, including interstitial lung disease, they mentioned.

Reference:

Naito A et al. Contributions of anemia to exercise intolerance in heart failure with preserved ejection fraction-An exercise stress echocardiographic study. Int J Cardiol Heart Vasc. 2023 Aug 20;48:101255.  doi: 10.1016/j.ijcha.2023.101255