Estado del hierro en la insuficiencia cardiaca crónica: impacto en síntomas, clase funcional y capacidad de ejercicio submáxima

Enjuanes, Cristina; Bruguera, Jordi; Grau, María; Cladellas, Mercè; Gonzalez, Gina; Meroño, Oona; Moliner-Borja, Pedro; Verdú, José María; Farré, Núria; Comín‐Colet, Josep

doi:10.1016/j.recesp.2015.08.017

Cited by 61 publications

(8 citation statements)

References 27 publications

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“…sTfR is a biomarker that provides information on tissue iron demand and because it is insensitive to inflammation, it can detect anemia in patients with preexisting inflammatory states, which is particularly useful in distinguishing between anemia of chronic disease and anemias caused by lack of iron intake [33][34][35]. Previous studies of our group had already shown its ability to predict effort capacity and quality of life in patients with chronic HF globally [18], and this paper studies its impact and predictive value specifically in HFpEF compared with other iron metabolism biomarkers and explores differences along the HFpEF LVEF range.…”

Section: Functional Capacity Impairment and Quality Of Life Worseningmentioning

confidence: 99%

“…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%

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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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Section: Functional Capacity Impairment and Quality Of Life Worseningmentioning

confidence: 99%

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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“…Of importance, ID is not only associated with anemia, but also higher morbidity and mortality among certain chronic diseases, which could be alleviated after treatment [100,182,183,184,185]. For example, in patients suffering from chronic heart failure, ID has been shown to adversely impact performance status and quality of life, including prolonged hospitalizations independent of anemia [186,187,188]. Another significant upcoming challenge will be the management of anemia of the elderly, which often has a heterogeneous and multifactorial etiology, but is also specifically related to age-related changes [189].…”

Section: Perspectivesmentioning

confidence: 99%

Established and Emerging Concepts to Treat Imbalances of Iron Homeostasis in Inflammatory Diseases

2018

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Inflammation, being a hallmark of many chronic diseases, including cancer, inflammatory bowel disease, rheumatoid arthritis, and chronic kidney disease, negatively affects iron homeostasis, leading to iron retention in macrophages of the mononuclear phagocyte system. Functional iron deficiency is the consequence, leading to anemia of inflammation (AI). Iron deficiency, regardless of anemia, has a detrimental impact on quality of life so that treatment is warranted. Therapeutic strategies include (1) resolution of the underlying disease, (2) iron supplementation, and (3) iron redistribution strategies. Deeper insights into the pathophysiology of AI has led to the development of new therapeutics targeting inflammatory cytokines and the introduction of new iron formulations. Moreover, the discovery that the hormone, hepcidin, plays a key regulatory role in AI has stimulated the development of several therapeutic approaches targeting the function of this peptide. Hence, inflammation-driven hepcidin elevation causes iron retention in cells and tissues. Besides pathophysiological concepts and diagnostic approaches for AI, this review discusses current guidelines for iron replacement therapies with special emphasis on benefits, limitations, and unresolved questions concerning oral versus parenteral iron supplementation in chronic inflammatory diseases. Furthermore, the review explores how therapies aiming at curing the disease underlying AI can also affect anemia and discusses emerging hepcidin antagonizing drugs, which are currently under preclinical or clinical investigation.

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“…Teniendo en cuenta los datos de estudios prospectivos que demuestran mejoría clínica con la administración de hierro en pacientes con deficiencia de hierro, una precoz detección debiera considerarse, con mayor relevancia, como objetivo terapéutico en el tratamiento de la IC. Nuestros resultados tan solo pretenden poner de manifiesto este aspecto en la práctica médica habitual, con escasas determinaciones analíticas de los niveles de hierro en pacientes con insuficiencia cardíaca (26)(27)(28)(29)(30) .…”

Section: Criterios De Exclusiónunclassified

Frequency of iron deficiency in patients with heart failure

Escurra

Taboada

2019

Rev. Nac. (Itauguá)

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RESUMENIntroducción: la deficiencia de hierro es una comorbilidad en pacientes con insuficiencia cardiaca que puede provocar graves consecuencias clínicas y generar mal pronóstico.Objetivos: determinar la frecuencia de anemia ferropénica en pacientes internados con insuficiencia cardiaca y describir sus características demográficas y clínicas de los pacientes.Metodología: observacional descriptivo prospectivo de corte transversal. Se incluyó a pacientes varones y mujeres, mayores de 18 años de edad, portadores de insuficiencia cardiaca, internados en el Hospital Nacional (Itauguá, Paraguay) en años 2017-2018. Se midieron variables clínicas y laboratoriales. Se consideró anemia ferropénica a todo valor de hemoglobina ≤13 g/dL en hombres y ≤ 12 g/dL en mujeres con ferritina <100 µg/L. Resultados: se incluyeron 152 pacientes con edad media 68±14 años y siendo 57% del sexo masculino. Entre las comorbilidades predominó la hipertensión arterial (95%). Se encontró 72% de sujetos con anemia ferropénica, siendo la frecuencia superior en los grados II y III de la clasificación funcional de la NYHA Conclusión: La frecuencia de anemia ferropénica en pacientes con IC fue 72% y predominó en el sexo masculino y con clase funcional II-III. La comorbilidad más frecuente fue la hipertensión arterial. Palabras clave: insuficiencia cardiaca, anemia ferropénica, ferritinas Artículo original Frecuencia de ferropenia en pacientes con insuficiencia cardíaca Frequency of iron deficiency in patients with heart failure ABSTRACT Introduction: iron deficiency is a comorbidity in patients with heart failure with can cause serious clinical consequences and generate poor prognosis. Objectives: to determine the frequency of iron deficiency anemia in patients hospitalized with heart failure and to describe their demographic and clinical characteristics. Methodology: observational, descriptive, prospective, cross-sectional. Were included male and female patients, older than 18 years of age, with heart failure, admitted to the National Hospital (Itauguá, Paraguay) in the years 2017-2018. Clinical and laboratory variables were measured. Iron-deficiency anemia was considered in patients with hemoglobin value ≤ 13 g / dL in men and ≤ 12 g / dL in women with ferritin <100 μg / L.Results: 152 patients were included, with a mean age of 68 ± 14 years being 57% males. Between comorbidities, arterial hypertension was prevalent (95%). 72% of subjects with iron deficiency anemia were found, the frequency being higher in grades II and III of the NYHA functional classification Conclusion: The frequency of iron deficiency anemia in patients with HF was 72% and was prevalent in males with functional class II-III. The most frequent comorbidity was arterial hypertension.

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Estado del hierro en la insuficiencia cardiaca crónica: impacto en síntomas, clase funcional y capacidad de ejercicio submáxima

Cited by 61 publications

References 27 publications

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

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

Established and Emerging Concepts to Treat Imbalances of Iron Homeostasis in Inflammatory Diseases

Frequency of iron deficiency in patients with heart failure

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