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Iron deficiency and short-term adverse events in patients with decompensated heart failure

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Abstract

Background

For patients with heart failure (HF), iron deficiency (ID) is a common therapeutic target. However, little is known about the utility of transferrin saturation (TSAT) or serum ferritin for risk stratification in decompensated HF (DHF) or the European Society of Cardiology's (ESC) current definition of ID (ferritin < 100 μg/L or TSAT < 20% if ferritin is 100–299 μg/L). We evaluated the association between these potential markers of ID and the risk of 30-day readmission for HF or death in patients with DHF.

Methods

We retrospectively included 1701 patients from a multicenter registry of DHF. Serum ferritin and TSAT were evaluated 24–72 h after hospital admission, and multivariable Cox regression was used to assess their association with the composite endpoint.

Results

Participants' median (quartiles) age was 76 (68–82) years, 43.8% were women, and 51.7% had a left ventricular ejection fraction > 50%. Medians for NT-proBNP, TSAT, and ferritin were 4067 pg/mL (1900–8764), 14.1% (9.0–20.3), and 103 ug/L (54–202), respectively. According to the current ESC definition, 1,246 (73.3%) patients had ID. By day 30, there were 177 (10.4%) events (95 deaths and 85 HF readmission). After multivariable adjustment, lower TSAT was associated with outcome (p = 0.009) but serum ferritin was not (HR 1.00; 95% confidence interval 0.99–1.00, p = 0.347).

Conclusions

Lower TSAT, but not ferritin, was associated with a higher risk of short-term events in patients with DHF. Further research is needed to confirm these findings and the utility of serum ferritin as a marker of ID in DHF.

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References

  1. Okonko, D. O., Mandal, A. K., Missouris, C. G., & Poole-Wilson, P. A. (2011). Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival. Journal of the American College of Cardiology, 58, 1241–1251.

    Article  CAS  Google Scholar 

  2. Cleland, J. G., Zhang, J., Pellicori, P., et al. (2016). Prevalence and outcomes of anemia and hematinic deficiencies in patients with chronic heart failure. JAMA Cardiol, 1, 539–547.

    Article  Google Scholar 

  3. Ambrosy, A. P., Gurwitz, J. H., Tabada, G. H., et al. (2019). Incident anaemia in older adults with heart failure: rate, aetiology, and association with outcomes. Eur Heart J Qual Care Clin Outcomes, 5, 361–369.

    Article  Google Scholar 

  4. Moliner, P., Jankowska, E. A., van Veldhuisen, D. J., et al. (2017). Clinical correlates and prognostic impact of impaired iron storage versus impaired iron transport in an international cohort of 1821 patients with chronic heart failure. International Journal of Cardiology, 243, 360–366.

    Article  Google Scholar 

  5. Grote Beverborg, N., Klip, I. T., Meijers, W. C., et al. (2018). Definition of iron deficiency based on the gold standard of bone marrow iron staining in heart failure patients. Circulation. Heart Failure, 11, e004519.

    Article  CAS  Google Scholar 

  6. Gentil, J. R. S., Fabricio, C. G., Tanaka, D. M., et al. (2020). Should we use ferritin in the diagnostic criteria of iron deficiency in heart failure patients? Clin Nutr ESPEN, 39, 119–123.

    Article  Google Scholar 

  7. Anker, S. D., Comin Colet, J., Filippatos, G., et al. (2009). Ferric carboxymaltose in patients with heart failure and iron deficiency. New England Journal of Medicine, 361, 2436–2448.

    Article  CAS  Google Scholar 

  8. Ponikowski, P., van Veldhuisen, D. J., Comin-Colet, J., et al. (2015). Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. European Heart Journal, 36, 657–668.

    Article  CAS  Google Scholar 

  9. Anker, S. D., Kirwan, B. A., van Veldhuisen, D. J., et al. (2018). Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. European Journal of Heart Failure, 20, 125–133.

    Article  CAS  Google Scholar 

  10. Mistry, R., Hosoya, H., Kohut, A., & Ford, P. (2019). Iron deficiency in heart failure, an underdiagnosed and undertreated condition during hospitalization. Annals of Hematology, 98, 2293–2297.

    Article  CAS  Google Scholar 

  11. Cohen-Solal, A., Damy, T., Terbah, M., et al. (2014). High prevalence of iron deficiency in patients with acute decompensated heart failure. European Journal of Heart Failure, 16, 984–991.

    Article  CAS  Google Scholar 

  12. Ponikowski, P., Kirwan, B. A., Anker, S. D., et al. (2020). Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicenter, double-blind, randomized, controlled trial. Lancet, 396, 1895–1904.

    Article  CAS  Google Scholar 

  13. Farmakis, D., Parissis, J., Lekakis, J., & Filippatos, G. (2015). Acute heart failure: epidemiology, risk factors, and prevention. Revista Espanola de Cardiologia, 68, 245–248.

    Article  Google Scholar 

  14. Ponikowski, P., Voors, A. A., Anker, S. D., et al. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Journal of Heart Failure, 18, 891–975.

    Article  Google Scholar 

  15. Nutritional anaemias. Report of a WHO scientific group. (1968). World Health Organ. Tech Rep Ser, 405, 5–37.

    Google Scholar 

  16. Rocha, B. M. L., Cunha, G. J. L., & MenezesFalcão, L. F. (2018). The burden of iron deficiency in heart failure: therapeutic approach. Journal of the American College of Cardiology, 71, 782–793.

    Article  CAS  Google Scholar 

  17. Nunez, J., Comin-Colet, J., Miñana, G., et al. (2016). Iron deficiency and risk of early readmission following a hospitalization for acute heart failure. European Journal of Heart Failure, 18, 798–802.

    Article  CAS  Google Scholar 

  18. Pasricha, S. R., Tye-Din, J., Muckenthaler, M. U., & Swinkels, D. W. (2020). Iron deficiency. Lancet. https://doi.org/10.1016/S0140-6736(20)32594-0

    Article  PubMed  Google Scholar 

  19. WHO. (2011). Serum Ferritin Concentrations for The Assessment of Iron Status and Iron Deficiency in Populations. World Health Organization, Geneva: Vitamin and Min-eral Nutrition Information System.

    Google Scholar 

  20. Silvestre, O. M., Gonçalves, A., Nadruz, W., Jr., et al. (2017). Ferritin levels and risk of heart failure-the atherosclerosis risk in communities study. European Journal of Heart Failure, 19, 340–347.

    Article  CAS  Google Scholar 

  21. Cacoub, P., Vandewalle, C., & Peoc’h, K. (2019). Using transferrin saturation as a diagnostic criterion for iron deficiency: a systematic review. Critical Reviews in Clinical Laboratory Sciences, 56, 526–532.

    Article  CAS  Google Scholar 

  22. Jankowska, E. A., Kasztura, M., Sokolski, M., et al. (2014). Iron deficiency defined as depleted iron stores accompanied by unmet cellular iron requirements identifies patients at the highest risk of death after an episode of acute heart failure. European Heart Journal, 35, 2468–2476.

    Article  CAS  Google Scholar 

  23. Hirsch, V. G., Tongers, J., Bode, J., et al. (2020). Cardiac iron concentration in relation to systemic iron status and disease severity in non-ischaemic heart failure with reduced ejection fraction. European Journal of Heart Failure, 22, 2038–2046.

    Article  CAS  Google Scholar 

  24. Núñez, J., Miñana, G., Cardells, I., et al. (2020). Noninvasive imaging estimation of myocardial iron repletion following administration of intravenous iron: the myocardial-IRON trial. J Am Heart Assoc. https://doi.org/10.1161/JAHA.119.014254

    Article  PubMed  PubMed Central  Google Scholar 

  25. Santas, E., Miñana, G., Cardells, I., et al. (2020). Myocardial-IRON investigators. Short-term changes in left and right systolic function following ferric carboxymaltose: a substudy of the Myocardial-IRON trial. ESC Heart Fail, 7, 4222–4230.

    Article  Google Scholar 

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Funding

This work was supported in part by an unrestricted grant from Vifor Pharma, CIBER Cardiovascular (Grant Numbers 16/11/00420 and 16/11/00403).

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Author notes

  1. Patricia Palau and Pau Llàcer contributed equally.

Authors and Affiliations

  1. Servicio de Cardiología, Hospital Clínico Universitario. INCLIVA. Universitat de València, Valencia, Spain

    Patricia Palau, Anna Mollar, Ana Martínez, Gema Miñana, Enrique Santas, Rafael De La Espriella, Eduardo Núñez & Julio Núñez

  2. Servicio de Medicina Interna. Hospital Universitario Ramón Y Cajal, Madrid, Spain

    Pau Llàcer & Luis Manzano

  3. FISABIO, Universitat Jaume I, Castellón, Spain

    Eloy Domínguez, Juan Pablo Tormo & Rim Zakarne

  4. Servicio de Cardiología, Hospital La Fe. Universitat de València, Valencia, Spain

    Luis Almenar

  5. Servicio de Cardiología, Hospital General Universitario de Valencia. Universitat de València, Valencia, Spain

    Lorenzo Fácila

  6. Institut del Cor, Hospital Universitari Germans Trias I Pujol, Badalona. Universitat Autònoma de Barcelona, Badalona, Spain

    Antoni Bayés-Genís

  7. CIBER Cardiovascular, Madrid, Spain

    Antoni Bayés-Genís & Julio Núñez

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  1. Patricia Palau
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Correspondence to Julio Núñez.

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Palau, P., Llàcer, P., Domínguez, E. et al. Iron deficiency and short-term adverse events in patients with decompensated heart failure. Clin Res Cardiol 110, 1292–1298 (2021). https://doi.org/10.1007/s00392-021-01832-z

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