Erythropoietin levels in heart failure after an acute myocardial infarction: Determinants, prognostic value, and the effects of captopril versus losartan

Belonje, Anne M.S.; Westenbrink, B. Daan; Voors, Adriaan A.; Haehling, Stephan von; Ponikowski, Pjotr; Anker, Stefan D.; van Veldhuisen, Dirk J.; Dickstein, Kenneth

doi:10.1016/j.ahj.2008.08.020

« Previous Next »American Heart Journal
Volume 157, Issue 1 , Pages 91-96, January 2009

Erythropoietin levels in heart failure after an acute myocardial infarction: Determinants, prognostic value, and the effects of captopril versus losartan

Anne M.S. Belonje, MD
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
B. Daan Westenbrink, MD
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
Adriaan A. Voors, MD, PhD
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
- Reprint requests: Adriaan A. Voors, MD, PhD, Department of Cardiology, Thoraxcenter, University Medical Center Groningen, Hanzeplein 1, P.O. Box 30001, 9700 RB Groningen, The Netherlands.
Stephan von Haehling, MD
- Department of Cardiology, Applied Cachexia Research, Charité, Campus Virchow-Klinikum, Berlin, Germany
Pjotr Ponikowski, MD, PhD
- Department of Cardiology, Military Hospital, Wroclaw, Poland
Stefan D. Anker, MD, PhD
- Department of Cardiology, Applied Cachexia Research, Charité, Campus Virchow-Klinikum, Berlin, Germany
Dirk J. van Veldhuisen, MD, PhD
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
Kenneth Dickstein, MD, PhD
- Department of Cardiology, University of Bergen, Stavanger University Hospital, Stavanger, Norway

Received 2 May 2008; accepted 21 August 2008. published online 29 October 2008.

Background

In patients with chronic heart failure, erythropoietin (Epo) levels are increased and related to a poor prognosis. Furthermore, Epo levels in these patients show a weak correlation with hemoglobin levels.

Methods

This is a retrospective analysis of a subgroup of the OPTIMAAL (Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan) trial in which serum Epo levels were measured at baseline, at 1 month, and at 1 and 2 years in 224 patients with an acute myocardial infarction complicated by signs or symptoms of heart failure. We investigated the determinants and the prognostic role of elevated Epo levels in these patients, and we studied the change in Epo levels by either captopril or losartan.

Results

The correlation between Epo and hemoglobin at baseline (r = 0.348, P < .001) and after 1 month (r = 0.272, P < .001) disappeared after 1 year of follow up (r = 0.129, P = .102). At 1 year, C-reactive protein was the only factor associated with Epo levels. Higher Epo levels at baseline were independently related to a higher mortality during 2 years of follow-up (hazard ratio 2.84, P = .014). In the captopril group, logEpo levels decreased from 1.19 (±0.26) to 0.95 (±0.20) mIU/mL, and in the losartan group from 1.19 (±0.27) to 1.01 (±0.17) mIU/mL (P = .036 between groups).

Conclusion

In this substudy of the OPTIMAAL trial, the correlation between Epo and hemoglobin disappeared in early post–acute myocardial infarction heart failure patients. Furthermore, elevated Epo levels at baseline predicted increased mortality.