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Iron deficiency and red cell indices in patients with heart failure
Michał Tkaczyszyn1,2, Josep Comín-Colet3,4, Adriaan A Voors5
1Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
Insights
Iron deficiency is common in heart failure patients, even without anemia or abnormal red cell indices. Screening for iron deficiency is recommended as it impacts long-term survival.
Area of Science:
- Cardiology
- Hematology
- Internal Medicine
Background:
- Iron deficiency (ID) is prevalent in heart failure (HF) patients.
- The relationship between ID and red cell indices (RCI) in HF requires further investigation.
- The prognostic impact of ID, independent of RCI, needs clarification.
Purpose of the Study:
- To determine the prevalence of ID in HF patients with normal vs. abnormal RCI.
- To examine the associations between iron parameters and RCI in HF.
- To assess the prognostic consequences of ID independently of RCI.
Main Methods:
- Analysis of clinical data from 1821 HF patients.
- Definition of ID based on ferritin and transferrin saturation levels.
- Multivariable Cox proportional hazard regression models to assess mortality risk.
Main Results:
- ID was common in HF patients, occurring in 75% of anemic patients with low RCI and 36% of non-anemic patients with normal RCI.
- Iron parameters were independently associated with hemoglobin, MCV, MCH, MCHC, CHR, and RDW.
- A trend towards higher mortality was observed in patients with ID, even after adjusting for HF prognosticators and certain RCI.
Conclusions:
- Routine screening for ID in HF patients is recommended, regardless of anemia or abnormal RCI.
- ID has a detrimental impact on long-term survival in HF that is partially independent of RCI.
Aims:
To investigate the prevalence of iron deficiency (ID) in heart failure (HF) patients with normal vs. abnormal red cell indices (RCI), the associations between iron parameters and RCI, and prognostic consequences of ID independently of RCI.
Methods And Results:
We analysed clinical data of 1821 patients with HF [mean age 66 ± 13 years; 71% men; New York Heart Association class I/II/III/IV (11%/39%/44%/6%); left ventricular ejection fraction >45%: 19%]. Iron deficiency (ferritin <100 µg/L or ferritin 100-299 µg/L with transferrin saturation <20%) was common irrespective of the presence of anaemia (haemoglobin <12 g/dL in women and <13 g/dL in men) or low RCI, from 75% in anaemic subjects with low mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and MCH concentration (MCHC), to 36% in non-anaemic subjects with MCV, MCH, and MCHC above the lower limit of normal. After adjustment for clinical variables, iron parameters remained independently associated with haemoglobin, MCV, MCH, MCHC, mean reticulocyte haemoglobin content (CHR), and red cell distribution width (RDW). In multivariable Cox proportional hazard regression models there was a trend towards higher mortality in patients with vs. without ID when adjusted for relevant HF prognosticators and MCH or MCHC (but not haemoglobin, CHR or RDW).
Conclusions:
Patients with HF should be routinely screened for ID irrespective of the presence of anaemia or abnormal RCI. The detrimental impact of ID on long-term survival in HF is partially independent of RCI.