A sobreposição da Anemia com a Síndrome da Insuficiência Cardíaca: uma visão sobre a fisiopatologia, as repercussões clínicas e o prognóstico

Abstract

Heart failure (HF) is a common complication of several heart diseases and presents as pathophysiological mechanisms reduced contractility, increased diastolic pressures and pulmonary and systemic congestion. In this sense, it is a serious public health problem with high mortality, impact on quality of life and high costs related to hospitalizations. Although hospitalizations have decreased in Brazil in the last 20 years, mortality associated with HF has doubled. Given this context, the study sought to analyze the relationship between HF and anemia, addressing its pathophysiological aspects, clinical repercussions and prognosis, aiming at a better understanding of these clinical entities. To construct this article, a literature review was carried out with publications selected from the BVS, PubMed and CAPES Journal Portal platforms. The research used health descriptors such as “anemia”, “heart failure” and “pathology” and their English versions, extracted from the acronym DeCS. The combination of descriptors was performed using the Boolean operator "AND", and gray literature studies were also considered. Furthermore, the inclusion criteria were: studies with full access, published in the last 20 years (2005-2024) and in Spanish, English or Portuguese. The exclusion criteria were: unpublished studies, not fully accessible and outside the scope of the study. In this sense, iron deficiency, a consequence of the anemias under study, is of crucial discussion, since iron is necessary for the synthesis of hemoglobin and red blood cells. The characteristic of this condition is the dysregulation of iron metabolism, including elevated levels of inflammatory cytokines (such as IL-6 and TNF-α) that alter iron absorption in the intestine and the release of iron stored in macrophages and hepatocytes. The body's compensatory mechanisms in response to anemia include increased production of erythropoietin (EPO) and vasodilation, which attempts to improve oxygen supply to tissues. However, when hemoglobin levels are very low, tissue hypoxia induces increased cardiac output and activation of the sympathetic nervous system, which can cause and/or aggravate cases of Heart Failure, leading to deleterious hemodynamic changes, such as increased cardiac work and left ventricular hypertrophy. Therefore, it is important to recognize and treat anemia in patients with Heart Failure, promoting a diagnostic and therapeutic approach aimed at improving the prognosis and quality of life in these individuals.