Anemia in Heart Failure With a Preserved Ejection Fraction (HFPEF)

Heart failure frequently occurs in patients with a preserved ejection fraction (HFPEF) and
affected subjects are predominantly elderly women with several co-morbid conditions.
Despite the diversity of underlying clinical pathologies and co-morbid conditions present in
these patients, a common pathophysiologic explanation is generally applied to explain their
clinical symptoms. Our preliminary data show that a significant subgroup with HFPEF has
increases in ventricular volumes and expanded plasma volumes, consistent with a volume
overloaded state. In the setting of a preserved EF with end diastolic volume increased,
stroke volume must increase, indicating a high output state. Anemia may be an important,
modifiable contributor to the observed high output and volume overload as well as exercise
intolerance in elderly HFPEF patients, abnormal ventricular remodeling and impaired overall
health status and quality of life. This protocol evaluates the impact of treating anemia in
subjects with HFPEF. The specific aims of the current study are to provide a comprehensive
and mechanistically based assessment of how correcting anemia in subjects with HFPEF can
impact on functional capacity, ventricular structure and function and overall health status.
We propose to perform a randomized, prospective, double blind study in 80 subjects with
HFPEF to test the hypothesis that the administration of subcutaneous erythropoietin will be
associated with reverse ventricular remodeling, significant improvements in exercise
capacity and improved health status.