Cor Vasa 2026, 68(3):349-361

Pathophysiology of Anemia in Heart Failure: Mechanisms and Clinical Implications

Viktória Maľováa, b
a Department of Hematology and Transfusion Medicine, Nemocnica Poprad, Poprad, the Slovak Republic
b Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, the Slovak Republic

Anémia je častou komplikáciou srdcového zlyhávania (SZ) a jej prítomnosť je spojená s nepriaznivou prognózou nezávisle od ostatných rizikových faktorov. Postihuje až polovicu pacientov a často ju sprevádzajú zmeny erytrocytových indexov, ktoré odrážajú systémovú dysreguláciu. Patofyziológia anémie pri SZ je multifaktoriálna a zahŕňa hemodilúciu v dôsledku kongescie, poruchu produkcie erytropoetínu (EPO) a zníženú odpoveď kostnej drene v dôsledku renálnej hypoperfúzie, zápalu a uremického prostredia, funkčný deficit železa sprostredkovaný hepcidínom, nutričné faktory a vplyv farmakoterapie, skrátené prežívanie erytrocytov, ako aj oxidačný stres a mitochondriálnu dysfunkciu. Tieto vzájomne sa ovplyvňujúce mechanizmy sa odrážajú v bežne dostupných laboratórnych parametroch vrátane hemoglobínu, erytrocytových indexov, distribučnej šírky erytrocytov (RDW), feritínu a saturácie transferínu, ktoré poskytujú informácie o erytropoetickej aktivite, dostupnosti železa a obrate erytrocytov. Najmä RDW integruje poruchy erytropoézy a znížené prežívanie erytrocytov a konzistentne súvisí s nepriaznivou prognózou vo všetkých fenotypoch srdcového zlyhávania. Anémia pri srdcovom zlyhávaní preto predstavuje dynamický prejav multisystémovej dysregulácie, a nie izolovanú hematologickú poruchu. Hodnoty hemoglobínu je preto potrebné interpretovať v kontexte objemového stavu organizmu a metabolizmu železa, nie iba so zameraním na ich izolovanú korekciu. Budúci výskum by sa mal zamerať na fenotypizáciu založenú na biomarkeroch s cieľom lepšie identifikovať dominantné patofyziologické mechanizmy anémie pri srdcovom zlyhávaní. © 2026, ČKS.

Klíčová slova: Anémia, Deficit železa, Hepcidín, Oxidačný stres, Srdcové zlyhávanie,

Vloženo: 24. leden 2026; Revidováno: 24. leden 2026; Přijato: 10. duben 2026; Zveřejněno online: 2. červen 2012; Zveřejněno: 1. červenec 2026  Zobrazit citaci

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Maľová V. Pathophysiology of Anemia in Heart Failure: Mechanisms and Clinical Implications. Cor Vasa. 2026;68(3):349-361.
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