Prevalence and Clinical Impact of Iron Deficiency in Patients With Severe Aortic Stenosis Referred for Transcatheter Aortic Valve Implantation

Rheude, Tobias; Pellegrini, Costanza; Lessmann, Leonie; Wiebe, Jens; Mayr, N. Patrick; Michel, Jonathan; Trenkwalder, Teresa; Kasel, Albert Markus; Schunkert, Heribert; Kastrati, Adnan; Hüsser, Oliver; Hengstenberg, Christian

doi:10.1016/j.amjcard.2019.07.051

Cited by 8 publications

(20 citation statements)

References 23 publications

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“…In spite of this, HR values for cumulative mortality were higher for EPO than for anemia (HR 4.05, 95% CI 2.29–7.16, p < 0.001 for logEPO vs. HR 2.40, 95% CI 1.51–3.80, p < 0.001 for hemoglobin). As opposed to previous studies in patients with severe aortic stenosis undergoing TAVR ( 23 ), baseline iron deficiency did not have an impact on mortality in our cohort. Causes of both post-procedural and mid-term deaths showed no differences across EPO quartiles, suggesting EPO impact was not directly related to TAVR complications.…”

Section: Discussioncontrasting

confidence: 99%

Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Mas-Peiró

Seppelt

Rosa

et al. 2020

Front. Cardiovasc. Med.

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Background: Both EPO levels and anemia have shown prognostic value in several cardiac disorders. An observational study with a prospective follow-up was performed to investigate their independent prognostic roles in severe aortic stenosis.Methods: An up to 36-month follow-up of consecutive patients with severe aortic stenosis undergoing TAVR in a high-volume center was performed. Patients with eGRF <30 mL/min/1.73 m2 were excluded. EPO levels and/or anemia status and its association with mid-term mortality were assessed.Results: Out of 407, 360 met eligibility criteria. Median age was 83 years, with 71.4% having a NYHA class III/IV. Anemia was present in 51.9%, and iron deficiency in 52.8%. Median (IQR) EPO levels were 14.4 (9.30–24.30) mIU/mL. Median follow-up was 566 days. Anemia was associated with overall mortality (HR 2.40, 95% CI 1.51–3.80, p < 0.001). Higher logEPO levels were associated with mid-term mortality (HR 4.05, 95% CI 2.29–7.16, p < 0.001), even after adjusting for clinically and/or statistically relevant factors (multivariate HR 2.25, 95 CI 1.09–4.66, p = 0.029). Kaplan-Meier analyses showed early diverging curves for anemia vs. non-anemia, whereas curves for patients in various EPO level quartiles started to diverge at about 100 days, with differences consistently increasing during the subsequent entire follow-up period.Conclusions: Differently from anemia, which was a strong predictor for both early and late mortality in severe aortic stenosis after TAVR, independent prognostic value of EPO only emerged after post-TAVR recovery. EPO prognostic value was independent from anemia and mild-to-moderate renal dysfunction. High EPO levels could be useful to identify patients with severe aortic stenosis showing a compromised mid-term survival in spite of TAVR use and independently from early TAVR results.

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Section: Discussioncontrasting

confidence: 99%

Potential Role and Prognostic Value of Erythropoietin Levels in Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Mas-Peiró

Seppelt

Rosa

et al. 2020

Front. Cardiovasc. Med.

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“…7,8,17 In patients with severe aortic stenosis, only a few studies have examined the association between iron deficiency regardless of haemoglobin levels and adverse events following TAVI. 1,2 In an observational study on 495 patients undergoing TAVI, preprocedural iron deficiency was associated with adverse outcomes after TAVI. In a subgroup of patients (n = 56), intravenous iron resulted in improvements in both iron markers and symptoms at 30-day follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In an observational study on 495 patients undergoing TAVI, preprocedural iron deficiency was associated with adverse outcomes after TAVI. In a subgroup of patients ( n = 56), intravenous iron resulted in improvements in both iron markers and symptoms at 30‐day follow‐up 2 . Consequently, many have emphasized the need for clinical trials to investigate the potential benefit of intravenous iron in patients with severe aortic stenosis 2,18–20 …”

Section: Discussionmentioning

confidence: 99%

“…Iron deficiency is present in ∼50% of patients with severe aortic stenosis. 1,2 Iron is an essential micronutrient, and while its fundamental role in oxygen transport through erythropoiesis is well recognised, it is equally critical for energy production and efficient functioning of all of the body's organs. 3,4 Iron deficiency is a condition in which there is insufficient available iron to meet the body's needs.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with heart failure, intravenous iron improves exercise capacity, quality of life, myocardial function, and reduce the risk of heart failure hospitalisations 7–12 . In patients with severe aortic stenosis, observational data suggest that iron deficiency is associated with an unfavourable clinical profile and adverse outcomes 2 . Furthermore, the symptoms of iron deficiency, such as fatigue, dyspnoea, and reduced exercise capacity, are similar to the cardinal symptoms of symptomatic aortic stenosis 13,14 .…”

Section: Introductionmentioning

confidence: 99%

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