Pedro Moliner1, Ewa A Jankowska2, Dirk J van Veldhuisen3, Nuria Farre4, Piotr Rozentryt5, Cristina Enjuanes6, Lech Polonski5, Oona Meroño7, Adriaan A Voors3, Piotr Ponikowski2, Peter Van der Meer3, Josep Comin-Colet8. 1. Heart Failure Clinic, Cardiology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain. 2. Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland; Centre for Heart Diseases, Military Hospital, Wroclaw, Poland. 3. Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. 4. Heart Failure Program, Department of Cardiology, Hospital del Mar, Barcelona, Spain; Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain. 5. Third Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland. 6. Cardiovascular Diseases Research Group, IDIBELL (Bellvitge Biomedical Research Institute), Hospitalet de Llobregat, Barcelona, Spain; Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain. 7. Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain; Department of Cardiology, Hospital del Mar, Barcelona, Spain. 8. Cardiovascular Diseases Research Group, IDIBELL (Bellvitge Biomedical Research Institute), Hospitalet de Llobregat, Barcelona, Spain; Heart Diseases Biomedical Research Group, Program of Research in Inflammatory and Cardiovascular Disorders, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain. Electronic address: jcomin@bellvitgehospital.cat.
Abstract
AIMS: To define iron deficiency in chronic heart failure (CHF), both, ferritin<100μg/L (indicating reduced iron storage) and transferrin saturation (TSAT)<20% (indicating reduced iron transport) are used. The aim of the study was to evaluate clinical outcomes and prognosis of either low ferritin or low TSAT in patients with CHF. METHODS AND RESULTS: We evaluated the clinical impact of impaired iron storage (IIS) and impaired iron transport (IIT) either alone or in combination compared to patients with normal iron status (NIS), in an international cohort of 1821 patients with CHF with a mean age of 66±13years and mean left ventricular ejection fraction of 35%±15. Isolated IIS was observed in 219 patients (12%), isolated IIT in 454 (25%) and coexistence of both conditions (IIS+IIT) were seen in 389 (21%). In adjusted models we found that patients with IIS+IIT and patients with isolated IIT had higher NT-proBNP levels (OR 2.2 [1.6-3.1] and OR 2.1 [1.5-2.9] respectively) and worse quality of life (OR 1.8 [1.2-2.7] and OR 1.7 [1.2-2.5] respectively) compared with isolated IIS. Multivariate Cox analyses showed that IIS+IIT and isolated IIT were independently associated with all-cause mortality (OR 1.41 [1.06-1.86] and OR 1.47 [1.13-1.92] respectively). Patients with isolated IIS did not differ from NIS patients in terms of severity or outcomes. CONCLUSIONS: Impaired iron transport alone or in combination with impaired iron storage is associated with worse clinical profile and increased risk of mortality in patients with CHF. Patients with isolated impaired iron storage may have a milder form of iron deficiency.
AIMS: To define iron deficiency in chronic heart failure (CHF), both, ferritin<100μg/L (indicating reduced iron storage) and transferrin saturation (TSAT)<20% (indicating reduced iron transport) are used. The aim of the study was to evaluate clinical outcomes and prognosis of either low ferritin or low TSAT in patients with CHF. METHODS AND RESULTS: We evaluated the clinical impact of impaired iron storage (IIS) and impaired iron transport (IIT) either alone or in combination compared to patients with normal iron status (NIS), in an international cohort of 1821 patients with CHF with a mean age of 66±13years and mean left ventricular ejection fraction of 35%±15. Isolated IIS was observed in 219 patients (12%), isolated IIT in 454 (25%) and coexistence of both conditions (IIS+IIT) were seen in 389 (21%). In adjusted models we found that patients with IIS+IIT and patients with isolated IIT had higher NT-proBNP levels (OR 2.2 [1.6-3.1] and OR 2.1 [1.5-2.9] respectively) and worse quality of life (OR 1.8 [1.2-2.7] and OR 1.7 [1.2-2.5] respectively) compared with isolated IIS. Multivariate Cox analyses showed that IIS+IIT and isolated IIT were independently associated with all-cause mortality (OR 1.41 [1.06-1.86] and OR 1.47 [1.13-1.92] respectively). Patients with isolated IIS did not differ from NIS patients in terms of severity or outcomes. CONCLUSIONS: Impaired iron transport alone or in combination with impaired iron storage is associated with worse clinical profile and increased risk of mortality in patients with CHF. Patients with isolated impaired iron storage may have a milder form of iron deficiency.
Authors: Sarah Fitzsimons; Tee Joo Yeo; Lieng H Ling; David Sim; Kui Toh Gerard Leong; Poh Shuan Daniel Yeo; Hean Yee Ong; Fazlur Jaufeerally; Tze P Ng; Katrina Poppe; Mayanna Lund; Gerry Devlin; Richard Troughton; Carolyn S P Lam; A Mark Richards; Robert N Doughty Journal: ESC Heart Fail Date: 2021-09-30
Authors: Ridha I S Alnuwaysir; Martijn F Hoes; Dirk J van Veldhuisen; Peter van der Meer; Niels Grote Beverborg Journal: J Clin Med Date: 2021-12-27 Impact factor: 4.964
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