An Evaluation of the Causes of Anemia in Patients With Heart Failure

Inclusion Criteria: Groups 1 and 2 * Age \>18 years * Group 1: hemoglobin \< 120g/L in women and \< 130 g/L in men (in agreement with the WHO definition of anemia) * Group 2: hemoglobin \> or = 120g/L in women and \> or = 130 g/L in men * Patients with chronic HF referred to a specialized HF clinic, or with a diagnosis of HF at least 6 months prior to enrolment * NYHA functional class II-IV at the time of enrolment * Patients already on CHF medical therapy (ACEI or ARBs, beta-blockers if tolerated, with or without digoxin, and loop diuretics), at stable doses for \> or = 1 month * LVEF \< or = 40% within 6 months prior to patient enrolment, by echocardiography, radionuclide ventriculography or perfusion scan, or radiologic angiography Inclusion criteria - group 3 * Age \>18 years * At least moderate CRF (eGFR \< 60ml/min/1,73m2) * With or without anemia * LVEF \> or = 50% within 6 months prior to patient enrolment, by echocardiography, radionuclide ventriculography or perfusion scan, or radiologic angiography Exclusion Criteria (all groups): * Recent acute renal failure episode (\< 1 month) * Red blood cells (or other blood component) transfusions or EPO therapy within 3 months prior to enrolment * Iron, B12 or folic acid supplements used to treat anemia (\< 3 months) * Evidence of active GI bleeding * Recent acute coronary syndrome or decompensated HF episode (\< 1 month) * Complex congenital heart disease * Known malignant hematologic or other active neoplasia * Immunosuppressive therapy, chemotherapy or radiotherapy within 3 months prior to enrolment * Recent acute decompensation of a chronic inflammatory disease (e.g. chronic inflammatory bowel disease, rheumatoid arthritis, collagen vascular disease) within 3 months prior to enrolment * Recent viral or bacterial syndrome (\< 2 weeks) * Active or recent viral hepatitis (\< 3 months) * Pregnant women * Potential for non compliance to tests involved in this protocol * Incapacity to provide informed consent