Iron Deficiency in Heart Failure: A Practical Guide

Abstract

Iron is an element necessary for cells due to its capacity of transporting oxygen and electrons. One of the important co-morbidities in heart failure is iron deficiency. Iron has relevant biological functions, for example, the formation of haemoglobin, myoglobin and numerous enzymatic groups. The prevalence of iron deficiency increases with the severity of heart failure. For a long time, the influence of iron deficiency was underestimated especially in terms of worsening of cardiovascular diseases and of developing anaemia. In recent years, studies with intravenous iron agents in patients with iron deficiency and cardiovascular diseases indicated new insights in the improvement of therapy. Experimental studies support the understanding of iron metabolism. Many physicians remain doubtful of the use of intravenous iron due to reports of side effects. The aim of this review is to describe iron metabolism in humans, to highlight the influence of iron deficiency on the course and symptoms of heart failure, discuss diagnostic tools of iron deficiency and provide guidance on the use of intravenous iron.

The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure

“…TSAT reflects the amount of iron bound to circulating transferrin. ID is usually identified based on the levels of ferritin and TSAT but it is necessary to keep in mind that inflammation and oxidative stress may artificially increase ferritin concentrations, regardless of actual iron status [7]. Interestingly, the presence of ID in our analysis showed no influence of mortality in patients with …”

“…Most iron in the body is bound to haemoglobin (Hb), thus it is important to differentiate between ID with normal Hb and ID anaemia. The differential diagnosis of the different forms of anaemia is rather complex and ID and anaemia are important factors that limit patients' exercise capacity and can be used as predictors of unfavourable outcomes [6,7,8,9]. Therefore the influence of anaemia and ID on exercise capacity and outcomes is of outstanding interest in patients with HF.…”

“…International Journal of Cardiology 205 (2016) [6][7][8][9][10][11][12] The aetiology of anaemia in HF is a matter of ongoing debate. Using hospital discharge codes, Ezekowitz et al [5] showed that absolute ID was found in only 21% of patients discharged from hospital with a main diagnosis of HF.…”

Clinical implications of iron deficiency/anemia in heart failure and approach to the treatment

“…Sin embargo, sobre las bases de los estudios aquí revisados, la terapia EV con hierro debe ser tenida en cuenta en pacientes con deficiencia de este ion, y persistencia de los síntomas y deterioro en la calidad de vida, a pesar de estar recibiendo las terapias catalogadas como clase I y considerando los valores de ferritina y de saturación de transferrina 49,50 .…”

Iron restriction increases myoglobin gene and protein expression in Soleus muscle of rats

“…It is one of the causes of anemia, a disease that causes disability in thermoregulation during cold exposure, in psychomotor development and affects work capacity, among others, effects that have been shown, both in humans and experimental animals (Beard et al 1998, Gera and Sachdev 2002, Hass and Brownlie 2001, He et al 2008, Hegde et al 2006, Moy and Early 1999, Paiva et al 2000, Zimmermann et al 2005, Ebner and von Haehling 2013.…”