Iron Status in Chronic Heart Failure: Impact on Symptoms, Functional Class and Submaximal Exercise Capacity

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.rec.2015.08.018

Cited by 47 publications

(56 citation statements)

References 27 publications

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“…In this study, we have shown that impaired iron status (low ferritin and CHR, high sTfR and PHRC) is associated with worse physical fitness as assessed using different components of FFT. These results are consistent with a recent cross‐sectional study investigating the relationships between iron status and submaximal exercise capacity in more than 500 patients with stable HF with either reduced or preserved LVEF . In cited study, the authors have demonstrated, that the presence of ID, higher ferritin index (sTfR/log 10 ferritin) and sTfR, and lower TSAT were associated with a shorter distance covered in a 6‐min walking test.…”

Section: Discussionsupporting

confidence: 89%

Depleted iron stores are associated with inspiratory muscle weakness independently of skeletal muscle mass in men with systolic chronic heart failure

Tkaczyszyn

Drozd

Węgrzynowska‐Teodorczyk

et al. 2018

J cachexia sarcopenia muscle

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BackgroundSkeletal and respiratory muscle dysfunction constitutes an important pathophysiological feature of heart failure (HF). We assessed the relationships between respiratory muscle function, skeletal muscle mass, and physical fitness in men with HF with reduced left ventricular ejection fraction (HFrEF), and investigated the hypothesis of whether iron deficiency (ID) contributes to respiratory muscle dysfunction in these patients.MethodsWe examined 53 male outpatients with stable HFrEF without asthma or chronic obstructive pulmonary disease (age: 64 ± 10 years; New York Heart Association [NYHA] class I/II/III: 36/51/13%; ischaemic aetiology: 83%; all with left ventricular ejection fraction ≤40%) and 10 middle‐aged healthy men (control group). We analysed respiratory muscle function (maximal inspiratory and expiratory pressure at the mouth [MIP and MEP, respectively]), appendicular lean mass/body mass index (ALM/BMI; ALM was measured using dual‐energy X‐ray absorptiometry), physical fitness (components of Functional Fitness Test for Older Adults), and iron status.ResultsMIP, MEP, and ALM/BMI (but not MIP adjusted for ALM/BMI) were lower in men with HFrEF vs. healthy men. MIP, MEP, and MIP adjusted for ALM/BMI (but not ALM/BMI) were lower in men with HFrEF with vs. without ID. In a multivariable linear regression model lower serum ferritin (but not transferrin saturation) was associated with lower MIP independently of ALM/BMI, left ventricular ejection fraction, N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), and haemoglobin concentration. In multivariable linear regression models, lower MIP was associated with worse results in Functional Fitness Test when adjusted for ALM/BMI or relevant clinical variables (NYHA class, estimated glomerular filtration rate, NT‐proBNP, and haemoglobin concentration).ConclusionsIn men with HFrEF, low ferritin reflecting depleted iron stores is associated with inspiratory muscle weakness independently of skeletal muscle mass. Inspiratory muscle dysfunction correlates with worse physical fitness independently of either skeletal muscle mass or disease severity.

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Section: Discussionsupporting

confidence: 89%

Depleted iron stores are associated with inspiratory muscle weakness independently of skeletal muscle mass in men with systolic chronic heart failure

Tkaczyszyn

Drozd

Węgrzynowska‐Teodorczyk

et al. 2018

J cachexia sarcopenia muscle

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“…The efficacy of i.v. ferric carboxymaltose has been extensively examined in symptomatic iron‐deficient patients with CHF (HFrEF; LVEF ≤ 45%) . In the FAIR‐HF study, iron‐deficient CHF patients treated with i.v.…”

Section: Treatment and Management Of Iron Deficiency In Chronic Heartmentioning

confidence: 99%

“…Exercise intolerance and fatigue are defining features of patients with CHF. Studies have shown that iron deficiency, even before the onset of anaemia, can be particularly severe in patients with CHF, aggravating the underlying disease and negatively impacting symptoms, quality of life (QoL), exercise capacity, and clinical outcomes, and has been associated with an increased risk of mortality of 40–60% . In addition, iron deficiency has been shown to increase the risk of hospitalization in patients with CHF by two‐fold (relative risk 2.23, 95% confidence interval 1.59–3.42; P < 0.001) .…”

Section: Introductionmentioning

confidence: 99%

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Iron deficiency in chronic heart failure: case‐based practical guidance

2018

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In patients with chronic heart failure, iron deficiency, even in the absence of anaemia, can aggravate the underlying disease and have a negative impact on clinical outcomes and quality of life. The 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure recognize iron deficiency as a co‐morbidity in chronic heart failure and recommend iron status screening in all newly diagnosed patients with chronic heart failure. Furthermore, the guidelines specifically recommend considerations of intravenous iron therapy, ferric carboxymaltose, for the treatment of iron deficiency. However, in spite of these recommendations, iron deficiency remains often overlooked and undertreated. This may be due, in part, to the lack of clinical context and practical guidance accompanying the guidelines for the treating physician. Here, we provide practical guidance complemented by a case study to assist and improve the timely diagnosis, treatment, and routine management of iron deficiency in patients with chronic heart failure.

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“…Moreover, iron deficiency with or without anemia decreases aerobic performance and is associated with the development of fatigue [14]. In a single-center cross-sectional study of 538 stable patients with chronic HF, iron deficiency had an independent and linear association with submaximal exercise capacity according to the 6-min walk (6MWD) test and with symptomatic functional limitation according to the advanced New York Heart Association (NYHA) functional class [15]. Iron deficiency in HF has also been associated with increased hospitalizations [16].…”

Section: Outcomes Of Iron Deficiency In Hfmentioning

confidence: 99%

Management of Iron Deficiency in Heart Failure

2019

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Anemia is a common finding in patients with heart failure (HF). The cause for anemia is multifactorial, with iron deficiency being the most common cause. Anemia with HF is an established predictor of morbidity and mortality. Iron deficiency in systolic HF, even without anemia, has been associated with increased mortality, increased hospitalizations, and decreased functional capacity and quality of life measures. Data from several randomized controlled trials and meta-analyses of iron deficiency and systolic HF show a beneficial effect for intravenous (IV) iron in terms of quality of life and functional capacity (improvements in 6-min walk test, and improvements in New York Heart Association functional class), as well as decreased hospitalizations for HF and reduction in cardiovascular mortality rates. Limited evidence exists for a beneficial effect of IV iron in diastolic dysfunction. Patients with symptomatic systolic HF should undergo an anemia diagnostic work-up. When iron deficiency (defined as ferritin <100 ng/mL or serum ferritin 100–299 ng/mL and transferrin saturation <20%) is present, current evidence supports treating HF patients with iron deficiency with IV iron.

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Iron Status in Chronic Heart Failure: Impact on Symptoms, Functional Class and Submaximal Exercise Capacity

Cited by 47 publications

References 27 publications

Depleted iron stores are associated with inspiratory muscle weakness independently of skeletal muscle mass in men with systolic chronic heart failure

Depleted iron stores are associated with inspiratory muscle weakness independently of skeletal muscle mass in men with systolic chronic heart failure

Iron deficiency in chronic heart failure: case‐based practical guidance

Management of Iron Deficiency in Heart Failure

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