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Letter by Antonelli Incalzi et al Regarding Article, “Endogenous Erythropoietin and Outcome in Heart Failure”

2010; Lippincott Williams & Wilkins; Volume: 122; Issue: 10 Linguagem: Inglês

10.1161/circulationaha.110.940585

1524-4539

Raffaele Antonelli Incalzi, Claudio Pedone, Matteo Cesari,

Hemoglobinopathies and Related Disorders

HomeCirculationVol. 122, No. 10Letter by Antonelli Incalzi et al Regarding Article, "Endogenous Erythropoietin and Outcome in Heart Failure" Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLetter by Antonelli Incalzi et al Regarding Article, "Endogenous Erythropoietin and Outcome in Heart Failure" Raffaele Antonelli Incalzi, MD, Claudio Pedone, MD, PhD, MPH and Matteo Cesari, MD, PhD Raffaele Antonelli IncalziRaffaele Antonelli Incalzi Centro per la Salute dell'Anziano, Università Campus Bio-Medico, Rome, Italy , Claudio PedoneClaudio Pedone Centro per la Salute dell'Anziano, Università Campus Bio-Medico, Rome, Italy and Matteo CesariMatteo Cesari Centro per la Salute dell'Anziano, Università Campus Bio-Medico, Rome, Italy Originally published7 Sep 2010https://doi.org/10.1161/CIRCULATIONAHA.110.940585Circulation. 2010;122:e449To the Editor:We read with interest the article by Belonje and colleagues.1 It has merit in exploring the prognostic implications of serum erythropoietin and ratio of observed to expected erythropoietin in a large, unselected heart failure population (mean age, 71 years; women, 38%). A considerable proportion of these patients are likely affected by chronic obstructive pulmonary disease because its prevalence has been estimated to be 4% to 10% in the general population (with the number increasing with age and varying according to risk factors)2 and up to 33% in heart failure patients ≥65 years of age.3 As a consequence, some proportion of these patients are likely to have chronic obstructive pulmonary disease–related arterial hypoxemia, which is the strongest promoter of erythropoietin secretion.4 Accordingly, the observed erythropoietin levels cannot not be ascribed exclusively to heart failure and related pathogenetic mechanisms such as depressed renal function or inflammatory inhibition of bone marrow proliferation. Neither arterial blood gases nor percutaneous oxygen saturation is provided by the authors. In our opinion, the lack of this information makes it impossible to correctly interpret the prognostic meaning of erythropoietin concentration in heart failure. Thus, in both the clinical scenario and epidemiological research, it seems sensible to screen patients with heart failure for comorbid chronic obstructive pulmonary disease and arterial hypoxemia; unrecognized and then uncorrected hypoxemia is more likely to have prognostic implications than the ensuing increased erythropoietin.DisclosuresNone. References 1 Belonje AM, Voors AA, van der Meer P, van Gilst WH, Jaarsma T, van Veldhuisen DJ. Endogenous erythropoietin and outcome in heart failure. Circulation. 2010; 121: 245–251.LinkGoogle Scholar2 Halbert RJ, Isonaka S, George D, Iqbal A. Interpreting COPD prevalence estimates: what is the true burden of disease? Chest. 2003; 123: 1684–1692.CrossrefMedlineGoogle Scholar3 Havranek EP, Masoudi FA, Westfall KA, Wolfe P, Ordin DL, Krumholz HM. Spectrum of heart failure in older patients: results from the National Heart Failure project. Am Heart J. 2002; 143: 412–417.CrossrefMedlineGoogle Scholar4 Ebert BL, Bunn HF. Regulation of the erythropoietin gene. Blood. 1999; 94: 1864–1877.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetails September 7, 2010Vol 122, Issue 10 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.110.940585PMID: 20823396 Originally publishedSeptember 7, 2010 PDF download Advertisement SubjectsCardiorenal SyndromeCongenital Heart DiseaseEpidemiology