| Popis: |
Introduction. Frequent occurrence of anemia in chronic heart failure (CHF) may lead to further progression of the disease. The beneficial effects of correction of anemia in patients with chronic heart failure have already been proven. Patients and methods. In this six-month prospective study we enrolled 30 consecutive patients with reduced systolic left ventricular function (ejection fraction less than 35%) and clinically severe chronic heart failure (NYHA class III and IV). All patients had any type of anemia, defined as the blood concentration of hemoglobin less than 130 g/l in man and 120 g/l in woman. Patients with acute infection or malignant disease were excluded from the study ; we also did not include patients that were previously treated with folic acid or vitamin B12. After optimization of other medical therapy and cardiac compensation patients were randomized in two groups and basic laboratory parameters were taken. First group was treated with 5 mg. of folic acid per day (Folacin®, 5 mg. tbl, JGL) and the second with combination of 5 mg. of folic acid per day and 500 ug of vitamin B12 muscularly (Vitamin B12®, 500 μg, amp., Krka) every 14 days. After three months patients undergo for clinical reevaluation and all laboratory parameters were repeated. For next three months both groups were treated with 10 mg. of folic acid, and after six months of the randomizations we repeat clinical and laboratory findings. All patients in both groups were treated with per oral preparation of iron for six months during the study (feri-hidroksi polimaltozat, 100 mg, Ferum Lek®, chewing tbl, Lek). Primary goal was to follow plasma level of Nt-proBNP, established marker of severity and prognosis in CHF. Results. We find that treatment with vitamin B12 and folic acid led to a statistically significant reduction plasma level of Nt-proBNP in the both groups. There was no statistically significant difference between patients who received 5 mg of folic acid and those treated with folic acid and vitamin B12. Further reduction of Nt-proBNP concentration was achieved using 10 mg of folic acid either in patients who had previously received vitamin B12 or those who had not. After three months patients in both groups achieved a statistically significant correction of anemia. There was no significant reduction of pro inflammatory cytokines in any stage of research, neither between the two groups. However, in patients who previously had been receiving vitamin B12 therapy with 10 mg of folic acid for three months, led to reduction of TNF-α only slightly above the level of significance. Unlike the pro-inflammatory cytokines, the C-reactive protein level in serum showed a statistically significant reduction in patients receiving 5 mg of folic acid and it further declined with the increase of dose to 10 mg. All patients achieved a statistically significant improvement in quality of life (examined with modified Minnesota QuL questioner) and improvement of NYHA functional stages. Conclusion. In patients with severe chronic heart failure and anemia treatment with folic acid, additionally to per oral iron therapy can significantly reduce Nt-proBNP plasma concentration. This therapy led to significant correction of anemia, reduction of plasma CRP level, improvement of NYHA functional status and better quality of life. Addition of vitamin B12 did not have statistically important effect on the results, but in this group of patients reduction of pro-inflammatory cytokine TNF-α is slightly above the level of significance. |
