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Functional iron deficiency and diastolic function in heart failure with preserved ejection fraction

Mario Kasner1, Aleksandar S Aleksandrov, Dirk Westermann

  • 1Department of Cardiology and Pneumology, Charité-Universitaetsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany.

International Journal of Cardiology
|August 24, 2013
PubMed

Insights

Functional iron deficiency (FID) does not impact cardiac function or exercise capacity in patients with heart failure with preserved ejection fraction (HFPEF). Cardiac dysfunction in HFPEF is independent of FID in non-anemic individuals.

Area of Science:

  • Cardiology
  • Internal Medicine
  • Biochemistry

Background:

  • Functional iron deficiency (FID) is a known risk factor for adverse outcomes in advanced heart failure with reduced ejection fraction (HFrEF).
  • The role and impact of FID on cardiac performance in heart failure with preserved ejection fraction (HFPEF) remain largely uncharacterized.
  • This study investigates the association between FID and cardiac function in HFPEF patients.

Purpose of the Study:

  • To assess the impact of FID on cardiac performance in patients with HFPEF.
  • To determine if FID influences cardiac function as measured by pressure-volume loop analysis.
  • To explore the relationship between FID, cardiac mechanics, and exercise capacity in HFPEF.

Main Methods:

  • Twenty-six HFPEF patients underwent pressure-volume (PV) loop analysis, exercise testing, and echocardiography.
  • Iron metabolism was assessed via serum iron, ferritin, and transferrin saturation; FID was defined by specific ferritin and transferrin saturation thresholds.
  • Myocardial transferrin receptor expression was analyzed in endomyocardial biopsies from a subset of patients.

Main Results:

  • Fifteen of 26 HFPEF patients (58%) exhibited FID without anemia.
  • HFPEF patients with FID showed increased myocardial transferrin receptor expression compared to controls and non-FID HFPEF patients.
  • No significant differences in cardiac dimensions, systolic, or diastolic function were observed between HFPEF patients with and without FID.
  • Left ventricular (LV) stiffness correlated with peak oxygen uptake but not with iron status markers.
  • FID was not found to be related to exercise capacity, and its association with LV stiffness was independent of iron deficiency levels.

Conclusions:

  • In non-anemic patients with HFPEF, cardiac dysfunction and reduced exercise capacity are not associated with functional iron deficiency.
  • The findings suggest that FID does not play a significant role in the pathophysiology of cardiac dysfunction or exercise limitation in this patient cohort.
  • Further research may be warranted to elucidate other contributing factors to cardiac dysfunction and exercise intolerance in HFPEF.
Abstract

Keywords:
CODiastolic functionE/AE/E′EDPVREDVEFESPESVETE′/A′FIDHFPEFIVRTIron deficiencyLALAVILVLV end-diastolic pressureLV filling indexLV mass indexLVEDPLVMIPVSWS′TDITauVCO2VEVO2VTcardiac outputconstant of LV stiffness, exponential curve fit to EDPVRdP/dt(max)dP/dt(min)early (E′) to late (A′) diastolic velocity ratio of mitral annulusejection fractionend-diastolic pressure–volume relationshipend-diastolic volumeend-systolic pressureend-systolic volumeexercise testingfunctional iron deficiencyheart failure with preserved ejection fractionisovolumic relaxation timeisovolumic relaxation time constantleft atrialleft atrial volume indexleft ventriclemaximum rate of LV pressure changeminimum rate of LV pressure changepeak carbon dioxide outputpeak oxygen uptakepressure volumeratio of early peak (E) to late peak (A) mitral flow velocitiesstroke worksystolic velocity of mitral annulustissue Doppler imagingventilation equivalentventilatory (anaerobic) thresholdβ

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