Comparison of blood volume characteristics in anemic patients with low versus preserved left ventricular ejection fractions

Anemia is a significant co-morbidity in patients with heart failure (HF) irrespective of the ejection fraction and is routinely quantified by hemoglobin concentration. Hemodilution as a cause of anemia has been described in systolic HF. The aim of this study was to further investigate the effects of plasma volume in patients with HF by (1) assessing the prevalence of dilutional anemia in patients with anemia and preserved ejection fractions and (2) exploring the relation between hemoglobin and red cell volume in these patients. Forty-six patients with anemia (as determined by standard hemoglobin measurement), 22 with HF and low ejection fractions (HFLEF) and 24 with HF and preserved ejection fractions (HFPEF), all underwent plasma volume measurement with iodine-131-labeled albumin. Hemoglobin values did not differ between subjects with HFLEF and those with HFPEF (10.8 +/- 1.0 vs 11.0 +/- 1.0 g/dl, p = 0.55), but a red cell deficit was found in 88% of patients with HFPEF compared with 59% of those with HFLEF (p = 0.04). This was the result of a higher prevalence of an expansion of plasma volume in patients with HFLEF (100%) compared with those with HFPEF (71%). Among all patients, no correlation was found between hemoglobin and red cell volume (r = 0.09, p = 0.54), but a correlation did exist in patients with normal blood volumes (r = 0.55, p = 0.02). In conclusion, dilutional anemia caused by an expansion in plasma volume without a red cell deficit occurs more commonly in patients with HFLEF than those with HFPEF, and hemoglobin does not correlate with red cell volume in patients with anemia and HF.