Clinical correlates and prognostic impact of impaired iron storage versus impaired iron transport in an international cohort of 1821 patients with chronic heart failure

Moliner, Pedro; Jankowska, Ewa A.; Veldhuisen, Dirk J. van; Farré, Núria; Rozentryt, Piotr; Enjuanes, Cristina; Poloński, Lech; Meroño, Oona; Voors, Adriaan A.; Ponikowski, Piotr; Meer, Peter van der; Comín‐Colet, Josep

doi:10.1016/j.ijcard.2017.04.110

Cited by 46 publications

(63 citation statements)

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“…This concurs with a recent study where bone marrow iron staining was used to define ID 34 as well as with a publication from the European Iron Consortium cohort. 35 However, our results partly contrasts with results from the BIOSTAT-CHF study (n = 2357) showing that defective iron utilization in combination with low tissue iron storage (but not normal tissue iron storage) is associated with a worse prognosis. 36 These differences might be due to the higher prevalence of ID in the BIOSTAT-CHF study (61.6% vs. 33.8%) but also attributed to the fact that the BIOSTAT-CHF study comprise more than three times more CHF patients than our cohort, which might explain this disagreement.…”

Section: Discussioncontrasting

confidence: 99%

Anaemia, iron status, and gender predict the outcome in patients with chronic heart failure

et al. 2020

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Aims Anaemia and iron deficiency (ID) are frequently found in patients with chronic heart failure (CHF) and associated with adverse outcome. However, it is unclear whether absolute [transferrin saturation (TSAT) <20%, ferritin <100 μg/L] or inflammation-driven functional ID (TSAT <20%, ferritin >100 μg/L) with and without anaemia had similar or different consequences for such patients. Methods and results Within this retrospective cohort study, 2223 patients (1601 men and 622 women) with CHF, referred to our department, between 2000 and 2018, were followed for a median time of 84 months. Anaemia was found in 393 patients and was an independent predictor for an adverse outcome [HR 2.164 (95% CI 1.865-2.512), P < 0.001]. In 674 patients with available parameters of iron metabolism, ID was present in 228 patients and was associated with an unfavourable outcome [HR 1.499 (95% CI 1.158-1.940), P = 0.002]. ID was best predicting an adverse outcome in men ≤59 years, with heart failure with reduced ejection fraction, preserved kidney function, no inflammation, and a body mass index (BMI) ≥25.5 kg/ m 2. Functional ID in women and absolute ID in men were associated with poor prognosis. Of note, TSAT <20% but not low ferritin levels were predictive for an adverse outcome. Anaemic patients with high ferritin levels, advanced inflammation, older age, low BMI, male gender, and reduced glomerular filtration rate had the worst prognosis. Conclusions Anaemia and low tissue iron availability as reflected by TSAT <20% are negative predictors of outcome in patients with CHF. Systemic inflammation, renal function, BMI, age, and gender are important contributors for the clinical course.

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Section: Discussioncontrasting

confidence: 99%

Anaemia, iron status, and gender predict the outcome in patients with chronic heart failure

et al. 2020

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“…In nondialyzed patients with moderate to severe CKD, a reduction in TSAT is associated with an increase in all-cause mortality, independently of serum iron concentration 50 . In patients with CHF, a low TSAT index is independently associated with increased mortality in patients with normal serum iron, whereas a low ferritin concentration is not 49 .…”

Section: 5% (For 993 Laboratories)mentioning

confidence: 88%

“…The study of Bainton et al 22 in 1964, showed that the available iron supply in the body exhibited a better correlation with TSAT than with the plasma iron concentration in patients presenting with different degrees of ID and suffering from pathologies mimicking ID. TSAT is considered a good indicator of iron reserves in the bone marrow, and a value below 16% confirms iron deficient anemia, either absolute or functionnal 49 .…”

Section: 5% (For 993 Laboratories)mentioning

confidence: 99%

Using transferrin saturation as a diagnostic criterion for iron deficiency: A systematic review

Cacoub

Vandewalle²,

Peoc’h

2019

Critical Reviews in Clinical Laboratory Sciences

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Iron deficiency is the most common micronutrient deficiency in the world and represents a major challenge for public health, notably in terms of morbidity and mortality. It remains largely under-diagnosed due to the low level of exploration and the absence of international harmonization for biological tests and thresholds. We performed a systematic review of the literature using PubMed, which allowed us to identify 41 publications within the scope of this review. This analysis shows the benefit of using transferrin saturation in addition to ferritin, in the diagnosis of iron deficiency and even in first-line analysis for patients with chronic inflammatory diseases.

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“…Iron deficiency (ID) is a widespread comorbidity among HF patients, with prevalence ranging from 50% in HFrEF to 64% in HFpEF [10,11], and is associated with longer hospital lengths of stay and higher healthcare costs [12,13]. In HFrEF, ID has been thoroughly studied, and there is strong evidence showing an association between ID and worse exercise capacity and quality of life, and treatment with intravenous ferric carboxymaltose has been tested and approved with demonstrated clinical benefit [14][15][16][17][18][19]. However, there is less evidence regarding the same association in HFpEF [20], with evidence consisting of small observational and heterogenous studies, some of which suggest that ID may be associated with reduced functional capacity [21] and worse quality of life [22].…”

Section: Introductionmentioning

confidence: 99%

Iron Deficiency: Impact on Functional Capacity and Quality of Life in Heart Failure with Preserved Ejection Fraction

Alcaide-Aldeano

Garay

Alcoberro

et al. 2020

JCM

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The effects of iron deficiency (ID) have been widely studied in heart failure (HF) with reduced ejection fraction. On the other hand, studies in HF with preserved ejection fraction (HFpEF) are few and have included small numbers of participants. The aim of this study was to assess the role that ID plays in functional capacity and quality of life (QoL) in HFpEF while comparing several iron-related biomarkers to be used as potential predictors. ID was defined as ferritin <100 ng/mL or transferrin saturation <20%. Submaximal exercise capacity, measured by the 6-min walking test (6MWT), and QoL, assessed by the Minnesotta Living with Heart Failure Questionnaire (MLHFQ), were compared between iron deficient patients and patients with normal iron status. A total of 447 HFpEF patients were included in the present cross-sectional study, and ID prevalence was 73%. Patients with ID performed worse in the 6MWT compared to patients with normal iron status (ID 271 ± 94 m vs. non-ID 310 ± 108 m, p < 0.01). They also scored higher in the MLHFQ, denoting worse QoL (ID 49 ± 22 vs. non-ID 43 ± 23, p = 0.01). Regarding iron metabolism biomarkers, serum soluble transferrin receptor (sTfR) was the strongest independent predictor of functional capacity (β = −63, p < 0.0001, R2 0.39) and QoL (β = 7.95, p < 0.0001, R2 0.14) in multivariate models. This study postulates that ID is associated with worse functional capacity and QoL in HFpEF as well, and that sTfR is the best iron-related biomarker to predict both. Our study also suggests that the effects of ID could differ among HFpEF patients by left ventricular ejection fraction.

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Clinical correlates and prognostic impact of impaired iron storage versus impaired iron transport in an international cohort of 1821 patients with chronic heart failure

Cited by 46 publications

References 33 publications

Anaemia, iron status, and gender predict the outcome in patients with chronic heart failure

Anaemia, iron status, and gender predict the outcome in patients with chronic heart failure

Using transferrin saturation as a diagnostic criterion for iron deficiency: A systematic review

Iron Deficiency: Impact on Functional Capacity and Quality of Life in Heart Failure with Preserved Ejection Fraction

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