ANEMIA PADA GAGAL JANTUNG
Abstract
Sepertiga dari semua pasien dengan gagal jantung mengalami anemia, dan kehadirannya dikaitkan dengan keparahan gejala, peningkatan angka rawat inap, dan peningkatan angka kematian. Etiologi anemia bersifat multifaktorial, kompleks, dan bervariasi antar pasien. Penyebab utama terjadinya anemia pada gagal jantung adalah faktor inflamasi. Kadar hemoglobin berkorelasi negatif dengan penanda inflamasi seperti tumor necrosis factor-alpha, interleukin-6, dan protein C-reaktif, yang semuanya meningkat pada gagal jantung. Pengobatan anemia pada pasien gagal jantung dengan agen pemicu eritropoiesis telah dievaluasi secara intensif selama beberapa tahun terakhir. Sayangnya, agen ini tidak meningkatkan hasil dan dikaitkan dengan risiko efek samping tromboemboli yang lebih tinggi. Oleh karena itu, penggunaan ESA (Eritropoiesis-Stimulating Agents) untuk pengobatan anemia pada gagal jantung tidak dapat direkomendasikan. Terapi lain sedang dipelajari dan termasuk agen yang menargetkan reseptor eritropoietin, jalur hepsidin, atau penambah zat besi. Artikel ini berfokus pada patofisiologi anemia pada gagal jantung, evaluasi efektivitas modalitas terapi yang tersedia, dan terapi yang sedang diteliti yang dapat direkomendasikan sebagai pengobatan anemia pada gagal jantung
Keywords
Full Text:
PDFReferences
Kyriakou M, Kiff PF. Prognosis of the comorbid heart failure and Anemia: A systematic review and meta-analysis. Clin Trials Regul Sci Cardiol. 2016 Apr 1;16:12–21.
Groenveld HF, Januzzi JL, Damman K, van Wijngaarden J, Hillege HL, van Veldhuisen DJ, et al. Anemia and Mortality in Heart Failure Patients: A Systematic Review and Meta-Analysis. J Am Coll Cardiol. 2008 Sep 2;52(10):818–27.
Anand I, McMurray JJ V, Whitmore J, Warren M, Pham A, McCamish MA, et al. Anemia and Its Relationship to Clinical Outcome in Heart Failure. Circulation [Internet]. 2004;110(2):149–54. Available from: https://www.ahajournals.org/doi/abs/10.1161/01.CIR.0000134279.79571.73
Goodnough LT, Schrier SL. Evaluation and management of anemia in the elderly. Am J Hematol [Internet]. 2014;89(1):88–96. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ajh.23598
Anand IS, Gupta P. Anemia and Iron Deficiency in Heart Failure. Circulation [Internet]. 2018;138(1):80–98. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.118.030099
Opasich C, Cazzola M, Scelsi L, De Feo S, Bosimini E, Lagioia R, et al. Blunted erythropoietin production and defective iron supply for erythropoiesis as major causes of anaemia in patients with chronic heart failure. Eur Heart J [Internet]. 2005 Nov 1 [cited 2022 Nov 20];26(21):2232–7. Available from: https://academic.oup.com/eurheartj/article/26/21/2232/2888043
Van Der Meer P, Voors AA, Lipsic E, Smilde TDJ, Van Gilst WH, Van Veldhuisen DJ. Prognostic value of plasma erythropoietin on mortality in patients with chronic heart failure. J Am Coll Cardiol [Internet]. 2004 Jul 7 [cited 2022 Nov 19];44(1):63–7. Available from: https://www.jacc.org/doi/10.1016/j.jacc.2004.03.052
Deswal A, Petersen NJ, Feldman AM, Young JB, White BG, Mann DL. Cytokines and Cytokine Receptors in Advanced Heart Failure. Circulation [Internet]. 2001 Apr 24 [cited 2022 Nov 22];103(16):2055–9. Available from: https://www.ahajournals.org/doi/10.1161/01.CIR.103.16.2055
Shah R, Agarwal AK. Anemia associated with chronic heart failure: current concepts. Clin Interv Aging. 2013;8:111–22.
Anand IS. Anemia and Chronic Heart Failure: Implications and Treatment Options. J Am Coll Cardiol [Internet]. 2008;52(7):501–11. Available from: https://www.sciencedirect.com/science/article/pii/S0735109708018342
Metivier F, Marchais SJ, Guerin AP, Pannier B, London GM. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant [Internet]. 2000;15(suppl_3):14–8. Available from: https://doi.org/10.1093/oxfordjournals.ndt.a027970
McMahon LP, Mason K, Skinner SL, Burge CM, Grigg LE, Becker GJ. Effects of haemoglobin normalization on quality of life and cardiovascular parameters in end?stage renal failure. Nephrol Dial Transplant [Internet]. 2000;15(9):1425–30. Available from: https://doi.org/10.1093/ndt/15.9.1425
Ezekowitz JA, McAlister FA, Armstrong PW. Anemia Is Common in Heart Failure and Is Associated With Poor Outcomes. Circulation [Internet]. 2003;107(2):223–5. Available from: https://www.ahajournals.org/doi/abs/10.1161/01.CIR.0000052622.51963.FC
O’Meara E, Clayton T, McEntegart MB, McMurray JJ V, Lang CC, Roger SD, et al. Clinical Correlates and Consequences of Anemia in a Broad Spectrum of Patients With Heart Failure. Circulation [Internet]. 2006;113(7):986–94. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.105.582577
Komajda M, Anker SD, Charlesworth A, Okonko D, Metra M, Di Lenarda A, et al. The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET. Eur Heart J [Internet]. 2006;27(12):1440–6. Available from: https://doi.org/10.1093/eurheartj/ehl012
Sharma R, Francis DP, Pitt B, Poole-Wilson PA, Coats AJS, Anker SD. Haemoglobin predicts survival in patients with chronic heart failure: a substudy of the ELITE II trial. Eur Heart J [Internet]. 2004;25(12):1021–8. Available from: https://doi.org/10.1016/j.ehj.2004.04.023
Sabatine MS, Morrow DA, Giugliano RP, Burton PBJ, Murphy SA, McCabe CH, et al. Association of Hemoglobin Levels With Clinical Outcomes in Acute Coronary Syndromes. Circulation [Internet]. 2005;111(16):2042–9. Available from: https://www.ahajournals.org/doi/abs/10.1161/01.CIR.0000162477.70955.5F
Tang WHW, Tong W, Jain A, Francis GS, Harris CM, Young JB. Evaluation and Long-Term Prognosis of New-Onset, Transient, and Persistent Anemia in Ambulatory Patients With Chronic Heart Failure. J Am Coll Cardiol [Internet]. 2008;51(5):569–76. Available from: https://www.jacc.org/doi/abs/10.1016/j.jacc.2007.07.094
Grote Beverborg N, van Veldhuisen DJ, van der Meer P. Anemia in Heart Failure: Still Relevant? JACC Hear Fail [Internet]. 2018;6(3):201–8. Available from: https://www.sciencedirect.com/science/article/pii/S2213177917306212
Treatment of Anemia in Patients With Heart Disease: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med [Internet]. 2013;159(11):770–9. Available from: https://www.acpjournals.org/doi/abs/10.7326/0003-4819-159-11-201312030-00009
Swedberg K, Young JB, Anand IS, Cheng S, Desai AS, Diaz R, et al. Treatment of Anemia with Dar be po e tin Alfa in Systolic Heart Failure A bs t r ac t. N Engl J Med. 2013;368:1210–9.
Bello NA, Lewis EF, Desai AS, Anand IS, Krum H, McMurray JJ V, et al. Increased risk of stroke with darbepoetin alfa in anaemic heart failure patients with diabetes and chronic kidney disease. Eur J Heart Fail [Internet]. 2015;17(11):1201–7. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.412
Borovka M, Teruya S, Alvarez J, Helmke S, Maurer MS. Differences in Blood Volume Components Between Hyporesponders and Responders to Erythropoietin Alfa: The Heart Failure With Preserved Ejection Fraction (HFPEF) Anemia Trial. J Card Fail [Internet]. 2013;19(10):685–91. Available from: https://www.sciencedirect.com/science/article/pii/S1071916413010968
Singh AK, Szczech L, Tang KL, Barnhart H, Sapp S, Wolfson M, et al. Correction of Anemia with Epoetin Alfa in Chronic Kidney Disease A BS TR AC T. [cited 2022 Nov 28]; Available from: www.nejm.org
Lewis GD, Semigran MJ, Givertz MM, Malhotra R, Anstrom KJ, Hernandez AF, et al. Oral Iron Therapy for Heart Failure With Reduced Ejection Fraction. Circ Hear Fail [Internet]. 2016;9(5):e000345. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCHEARTFAILURE.115.000345
Okonko DO, Grzeslo A, Witkowski T, Mandal AKJ, Slater RM, Roughton M, et al. Effect of Intravenous Iron Sucrose on Exercise Tolerance in Anemic and Nonanemic Patients With Symptomatic Chronic Heart Failure and Iron Deficiency. J Am Coll Cardiol [Internet]. 2008;51(2):103–12. Available from: https://www.jacc.org/doi/abs/10.1016/j.jacc.2007.09.036
Toblli JE, Lombraña A, Duarte P, Gennaro F Di. Intravenous Iron Reduces NT-Pro-Brain Natriuretic Peptide in Anemic Patients With Chronic Heart Failure and Renal Insufficiency. J Am Coll Cardiol [Internet]. 2007;50(17):1657–65. Available from: https://www.jacc.org/doi/abs/10.1016/j.jacc.2007.07.029
Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency A BS TR AC T. N Engl J Med. 2009;17:2436–84.
Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. Eur Heart J [Internet]. 2014;36(11):657–68. Available from: https://doi.org/10.1093/eurheartj/ehu385
van Veldhuisen DJ, Ponikowski P, van der Meer P, Metra M, Böhm M, Doletsky A, et al. Effect of Ferric Carboxymaltose on Exercise Capacity in Patients With Chronic Heart Failure and Iron Deficiency. Circulation [Internet]. 2017;136(15):1374–83. Available from: https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.117.027497
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA Guideline for the Management of Heart Failure. J Am Coll Cardiol [Internet]. 2013;62(16):e147–239. Available from: https://www.jacc.org/doi/abs/10.1016/j.jacc.2013.05.019
F JG, S AJ, Ramon J. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. [cited 2022 Nov 28]; Available from: https://doi.org/10.1002/ejhf.592
Vadhan-Raj S, Abonour R, Goldman JW, Smith DA, Slapak CA, Ilaria RL, et al. A first-in-human phase 1 study of a hepcidin monoclonal antibody, LY2787106, in cancer-associated anemia. J Hematol Oncol [Internet]. 2017;10(1):73. Available from: https://doi.org/10.1186/s13045-017-0427-x
van Eijk LT, John ASE, Schwoebel F, Summo L, Vauléon S, Zöllner S, et al. Effect of the antihepcidin Spiegelmer lexaptepid on inflammation-induced decrease in serum iron in humans. Blood [Internet]. 2014;124(17):2643–6. Available from: https://doi.org/10.1182/blood-2014-03-559484
Ruckle J, Jacobs M, Kramer W, Pearsall AE, Kumar R, Underwood KW, et al. Single-Dose, Randomized, Double-Blind, Placebo-Controlled Study of ACE-011 (ActRIIA-IgG1) in Postmenopausal Women. J Bone Miner Res [Internet]. 2009;24(4):744–52. Available from: https://asbmr.onlinelibrary.wiley.com/doi/abs/10.1359/jbmr.081208
Iancu-Rubin C, Mosoyan G, Wang J, Kraus T, Sung V, Hoffman R. Stromal cell-mediated inhibition of erythropoiesis can be attenuated by Sotatercept (ACE-011), an activin receptor type II ligand trap. Exp Hematol [Internet]. 2013;41(2):155-166.e17. Available from: https://www.sciencedirect.com/science/article/pii/S0301472X12005966
Chen N, Qian J, Chen J, Yu X, Mei C, Hao C, et al. Phase 2 studies of oral hypoxia-inducible factor prolyl hydroxylase inhibitor FG-4592 for treatment of anemia in China. Nephrol Dial Transplant [Internet]. 2017;32(8):1373–86. Available from: https://doi.org/10.1093/ndt/gfx011
DOI: https://doi.org/10.32539/JKK.V10I1.19718
Refbacks
- There are currently no refbacks.
E-ISSN (Online) : 2614-0411
Jl. Dr. Moehammad Ali Kompleks RSMH Palembang 30126, Indonesia
Telp. 0711-352342, Fax.: 0711-373438
email: jurnalfkunsri@gmail.com
![Creative Commons License](https://i.creativecommons.org/l/by-sa/4.0/88x31.png)
Jurnal Kedokteran dan Kesehatan : Publikasi Ilmiah Fakultas Kedokteran Universitas Sriwijaya by https://ejournal.unsri.ac.id/index.php/jkk is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.