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

Abstract

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.

Diagnosis and Treatment of Iron Deficiency in Heart Failure: OFICSel study by the French Heart Failure Working Group

“…The ESC guidelines recommend IS only in patients with HFrEF 3 . However, in patients with HFpEF, ID is associated with worse functional capacity compared with patients with HFrEF 35,36 . Interestingly, of the 76 patients with HFmEF diagnosed with ID, 34 (44.7%) received IS.…”

“…3 However, in patients with HFpEF, ID is associated with worse functional capacity compared with patients with HFrEF. 35,36 Interestingly, of the 76 patients with HFmEF diagnosed with ID, 34 (44.7%) received IS. Similarly, of the 75 patients with HFpEF diagnosed with ID, 33 (44.0%) received IS.…”

Advanced heart failure

“…2, прогноз пациента с ПСН связан с большим числом факторов с наличием очевидной линейной связи (от слабой до почти функциональной) между многими из них. Например, качество жизни пациента с ХСН связано с полом, параметрами ремоделирования (геометрического и электрофизиологического) ЛЖ и его функционального состояния, уровнем астении и выраженностью депрессии, а также наличием метаболического синдрома (ожирение и индикаторы, отражающие выраженность системного воспаления и оксидативного стресса), железодефицита и коронарной недостаточности [33][34][35][36][37][38][39]. В свою очередь, депрессия вариабельности ритма сердца у этих больных прямо связана с возрастом, ремоделированием сердца, степенью систолической и диастолической дисфункции ЛЖ, наличием сахарного диабета и диабетической автономной нейропатии, а также клинической выраженностью сердечной недостаточности, и обратно -с эффективностью лечения ХСН [40][41][42][43], а гиперурикемия может быть одним из проявлений метаболического синдрома или хронической болезни почек [44][45][46].…”

Falla cardiaca con fracción de eyección preservada: generalidades y aproximación en el perioperatorio

“…Otras terapias farmacológicas que se han considerado para el tratamiento del síndrome son el uso de nitratos (44), inhibidores de la fosfodiesterasa 5 (45), inhibidores del receptor de angiotensina II y neprilisina (46) y ranolazina (47); sin embargo, los resultados no son concluyentes por lo que se necesitan estudios posteriores para emitir recomendaciones sólidas respecto al uso de los medicamentos en mención. En la actualidad se estudia el uso de hierro parenteral en el tratamiento y los desenlaces de pacientes con ICFEp, dos ensayos clínicos se encuentran en curso: el PRE-FER HF y el FAIR HFpEF cuyos resultados pueden orientar nuevos horizontes terapéuticos (48).…”