Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients

Beverborg, Niels Grote; Klip, IJsbrand T.; Meijers, Wouter C.; Voors, Adriaan A.; Vegter, Eline L.; Wal, Haye H. van der; Swinkels, Dorine W.; Pelt, Joost van; Mulder, André B.; Bulstra, Sjoerd K.; Vellenga, Edo; Mariani, Massimo A.; Boer, Rudolf A. de; Veldhuisen, Dirk J. van; Meer, Peter van der

doi:10.1161/circheartfailure.117.004519

Cited by 180 publications

(252 citation statements)

References 30 publications

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“…Assessment of iron stores on bone marrow sample can be considered the gold standard for diagnosis of ID. In a recent study by Grote Beverborg et al , the investigators assessed the validity of the above serum‐based definition of ID in a group of HF patients against bone marrow iron stores. The definition of ID based on ferritin < 100 ng/mL or Tsat < 20% had a positive predictive value of 66.7%.…”

Section: Iron Deficiency In Heart Failurementioning

confidence: 99%

Intravenous iron therapy in heart failure: a different perspective

Ghafourian

Chang

Ardehali

2019

European J of Heart Fail

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Section: Iron Deficiency In Heart Failurementioning

confidence: 99%

Intravenous iron therapy in heart failure: a different perspective

Ghafourian

Chang

Ardehali

2019

European J of Heart Fail

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“…Для постановки точного диагноза необходимо определить содержание сывороточного железа (СЖ), ферритина сыворотки крови, коэффициент насыщения трансферрина (КНТ), общую железосвязывающую способность сыворотки крови (ОЖССК), уровень растворимых рецепторов трансферрина (РРТ) и оценить дополнительные индексы эритроцитов и ретикулоцитов (содержание гипохромных эритроцитов (ГЭ / ц) и Hb в ретикулоцитах (HbР / ц)) [26,[39][40][41].…”

Section: диагностика анемии и железодефицита у больных снunclassified

“…ЖД при ХСН диагностируется как абсолютный при снижении сывороточного ферритина <100 мкг / л и КНТ (СЖ / ОЖССКх100 %) <20 % или относительный (функциональный) -при уровне сывороточного ферритина 100-299 мкг / л и КНТ <20 % [5,6,10,43,44]. [41,45]. Значительным научным достижением в сфере изучения метаболизма железа было открытие в 2001 г. гепсидина -гормона, регулирующего обмен железа [46,47].…”

Section: диагностика анемии и железодефицита у больных снunclassified

“…«Золотым стандартом» диагностики ЖД является определение уровня железа в КМ путем изучения его аспирата, окрашенного красителем Перлса, поскольку значения костномозгового железа не подвержены изменениям при воспалении [41,50]. Тем не менее исследование КМ в обычной клинической практике весьма ограничено из-за инвазивности метода, его дороговизны, субъективности трактовки результатов и сложности повторного выполнения [51].…”

Section: диагностика анемии и железодефицита у больных снunclassified

“…Вариабельность показателей ферритина и КНТ можно частично объяснить несоответствием между содержанием железа в крови и КМ. ОБЗОРЫ § В недавнем исследовании N. Grote Beverborg и рабочей группы, проведенном у 42 пациентов с СНнФВ, перенесших аорто-коронарное шунтирование, при исследовании КМ у 40 % (n=17) больных был диагностирован ЖД [41]. A. V. Hoffbrand и P. A. H. Moss полагают, что исследовать КМ необходимо только в тяжелых, осложненных случаях, при высоком подозрении на полное истощение депо железа в макрофагах и развивающихся эритробластах [53].…”

Section: диагностика анемии и железодефицита у больных снunclassified

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Anaemia and iron deficiency in chronic heart failure patients

et al. 2019

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Tis review focused on prevalence of anemia and iron defciency (ID) in CHF and their eﬀect on the course and prognosis of this condition. Based on evaluation of numerous laboratory data defnitions of anemia and ID were suggested. Specifcally, a diagnostic value of measuring serum iron, serum ferritin, transferrin saturation, total iron-binding capacity, and concentration of soluble transferrin receptors was discussed. Te review highlighted the importance of measuring bone marrow iron, which is rarely used in everyday clinical practice even though this test is considered a «gold standard» of ID diagnosis. Te review provided an insight into pathogenetic mechanisms of ID in CHF including insufcient iron supply, role of inﬂammation, erythropoietin, RAS, and eﬀects of some pharmacological therapies. Te authors described physiological consequences of ID and anemia, activation of hemodynamic and non-hemodynamic compensatory mechanisms, which develop in response to anemia and not infrequently aggravate CHF. Special atention was paid to current approaches to treatment of anemia and ID in CHF, including a discussion of efcacy and safety of oral and intravenous dosage forms of iron and hemopoiesis stimulators.

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Differences in Clinical Profile and Outcomes of Low Iron Storage vs Defective Iron Utilization in Patients With Heart Failure

et al. 2019

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IMPORTANCE Iron deficiency is present in half of patients with heart failure (HF) and is associated with increased morbidity and an impaired prognosis. Iron deficiency due to low iron storage (LIS) and defective iron utilization (DIU) are not entirely the same clinical problem, although they generally receive the same treatment. OBJECTIVE To define and describe similarities and differences between LIS and DIU in patients with HF. DESIGN, SETTING, AND PARTICIPANTS This analysis included data from 2 prospective observational studies: the Definition of Iron Deficiency in Chronic Heart Failure (DEFINE-HF) study, a single-center study conducted from 2013 to 2015 including 42 patients with a reduced left ventricular ejection fraction of 45% or less scheduled for coronary artery bypass graft surgery, and the A Systems Biology Study to Tailored Treatment in Chronic Heart Failure (BIOSTAT-CHF) study, a multinational study conducted from 2010 to 2014 including 2357 patients with worsening HF from 69 centers in 11 countries. The median (interquartile range) follow-up time was 1.8 (1.3-2.3) years. Data were analyzed from January 2018 to January 2019. MAIN OUTCOMES AND MEASURES The DEFINE-HF cohort was set up to derive a definition for different etiologies of iron deficiency using bone marrow iron staining as the criterion standard. This definition was applied to the BIOSTAT-CHF cohort to assess its association with clinical profile, biomarkers, and the primary composite end point of all-cause mortality or HF hospitalizations. RESULTS Among the 42 patients in the DEFINE-HF study, 10 (24%) were women, and the mean (SD) age was 68.0 (9.5) years. Low iron storage was defined as a bone marrow-validated combination of transferrin saturation less than 20% and a serum ferritin concentration of 128 ng/mL or less; DIU was defined as transferrin saturation less than 20% and a serum ferritin concentration greater than 128 ng/mL. These criteria were applied to 2356 patients with worsening HF in the BIOSTAT-CHF study; 1074 (45.6%) were women, and the mean (SD) age was 68.9 (12.0) years. A total of 1453 patients with worsening HF (61.6%) had iron deficiency, of whom 960 (66.1%) had LIS and 493 (33.9%) had DIU. Low iron storage was characterized by a higher proportion of anemia and a poorer quality of life, while DIU was characterized by higher levels of various inflammatory markers. Both LIS and DIU were associated with an impaired 6-minute walking test. Low iron storage was independently associated with the composite end point of all-cause mortality or HF hospitalizations (hazard ratio, 1.47; 95% CI, 1.26-1.71; P < .001), while DIU was not (hazard ratio, 1.05; 95% CI, 0.87-1.26; P = .64). CONCLUSIONS AND RELEVANCE In this study, both LIS and DIU were prevalent in patients with HF and had a distinct clinical profile. Only LIS was independently associated with increased rates of morality and HF hospitalizations, while DIU was not.

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Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients

Cited by 180 publications

References 30 publications

Intravenous iron therapy in heart failure: a different perspective

Intravenous iron therapy in heart failure: a different perspective

Anaemia and iron deficiency in chronic heart failure patients

Differences in Clinical Profile and Outcomes of Low Iron Storage vs Defective Iron Utilization in Patients With Heart Failure

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