Effect of erythropoietin on exercise capacity in patients with moderate to severe chronic heart failure

Background— Patients with chronic heart failure (CHF) are frequently anemic. An increase in hemoglobin could enhance exercise performance by increasing oxygen delivery. We investigated the effect of erythropoietin (EPO) on exercise performance in anemic patients with CHF. Methods and Results— Twenty-six anemic patients aged 57±11 years were randomized to receive EPO (15 000 to 30 000 IU per week) or placebo for 3 months. Parameters measured at baseline and end therapy included blood parameters (hemoglobin, hematocrit, plasma volume), exercise parameters (peak oxygen consumption [O2], exercise duration, 6-minute walk), muscle aerobic metabolism (half-time of O2 and near infrared recovery), and forearm vasodilatory function. EPO was well tolerated by all patients. Twelve patients in the EPO group felt improvement versus 1 in the placebo group (P<0.05). There were significant increases in hemoglobin (11.0±0.5 to 14.3±1.0 g/dL, P<0.05), peak O2 (11.0±1.8 to 12.7±2.8 mL · min-1 · kg-1, P<0.05) and exercise duration (590±107 to 657±119 s, P<0.004) in the EPO group but no significant changes in the control group. Resting and hyperemic forearm vascular resistance and indices of the rate of muscle oxidative capacity were unchanged in both groups. Conclusion— EPO significantly enhances exercise capacity in patients with CHF. One mechanism of improvement in O2 is increased oxygen delivery from increased hemoglobin concentration