Hemoglobin Level Threshold in Myelodysplastic Syndrome: Cardiac Hypertrophy and Quality of Life

Anemia is a frequent complication in myelodysplastic syndrome (MDS). Treatment with recombinant human epoetin, though effective in up to 40% of patients, is generally limited by financial constraints. On the other hand, anemia has been associated with increased cardiac morbidity and mortality. The main hemodynamic factor is the increased cardiac output mediated by lower afterload, higher preload and positive inotropic and chronotropic effects, leading to gradual cardiac enlargement and left ventricular hypertrophy (LVH). The important relationship between anemia and cardiac morbidity has never been investigated in MDS. We evaluated this association, together with quality of life (QOL) dimensions, in a cross-sectional study in 34 MDS patients. Mean age was 70 (range 41–88) years. QOL measures were obtained by applying the MDS-specific questionnaire QOL-E©. Echocardiographic measurements were carried out according to the recommendations of the American Society of Echocardiography by an external investigator who was blind to the biochemical results. Since 11 patients were transfusion-dependent and 23 were transfusion-free with mean Hb concentration of 10.9 (SD ± 2) g/dL, two groups of patients were formed initially. The groups were comparable for body mass index (BMI), weight, age, blood pressure and heart rate. Echocardiography detected significant cardiac remodeling in 10 out of 11 transfusion-dependent vs 11 out of 23 transfusion-free patients (p=0.01), associated with lower mean Hb levels (8.7±1.5 g/dL versus 11.5±2.4 g/dL, p