Backgrounds: Cardio-renal anemia syndrome (CRAS) has the prognostic significance in patients (pts) with heart failure. There is a difference in mode of death (cardiac [sudden vs pump failure death] vs non-cardiac death) between heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF). However, there is no information available on the different impact of CRAS in the prediction of mode of death in pts with acute decompensated heart failure (ADHF), relating to HFpEF and HFrEF.
Methods and Results: We studied 303 pts admitted for ADHF and discharged with survival (HFpEF(LVEF≥50%);n=140, HFrEF(LVEF<50%); n=163). As an index of CRAS at the admission, we proposed a new variable : product of creatinine (Cr) and blood urea nitrogen (BUN) divided by hemoglobin (Hb), CrхBUN/Hb. During a follow-up period of 5.1±4.3 yrs, 65 pts had cardiac death (sudden cardiac death in 37 and pump failure death in 27 pts) and 56 pts had non-cardiac death. CrхBUN/Hb was significantly associated with cardiac death, while there was no association between CrхBUN/Hb and non-cardiac death. CrхBUN/Hb of 1.613 was a fair discriminator for cardiac death (AUC 0.750[0.684-0.817]). In pts with HFrEF, higher CrхBUN/Hb (>1.613) was significantly associated with cardiac death (adjusted HR 4.0 [95%CI 1.8-9.0], p=0.0009), independently of prior heart failure hospitalization, BMI, systolic blood pressure and serum sodium level. In pts with HFpEF, higher CrхBUN/Hb was also significantly associated with cardiac death (adjusted HR 24.2 [95%CI 5.0-116.8], p<0.0001), independently of left atrial dimension index. Furthermore, pts with higher CrхBUN/Hb had significantly increased risk of sudden cardiac death and pump failure death in both groups with HFrEF and HFpEF.
Conclusion: CrхBUN/Hb as an index of CRAS, which is easily obtained in the usual clinical setting, would be useful to stratify the risk of mode of death in ADHF patients, regardless of HFrEF or HFpEF.