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Iron Laboratory Studies in Pediatric Patients With Heart Failure from Dilated Cardiomyopathy
David Higgins1, Jessica Otero2, Christa Jefferis Kirk2
1Division of Cardiology, Seattle Children's Hospital, University of Washington, Seattle, Washington.
Insights
Iron deficiency (FeD) is prevalent in children with heart failure (HF), impacting disease severity and mortality. Early detection and management of FeD in pediatric HF patients are crucial for improving outcomes.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Research
- Nutritional Science
Background:
- Iron deficiency (FeD), with or without anemia, is linked to adverse outcomes in adult heart failure (HF).
- The prevalence and impact of FeD in pediatric patients with HF remain largely undescribed.
- Understanding iron status in children with HF is essential for potential therapeutic interventions.
Purpose of the Study:
- To investigate the prevalence of FeD in pediatric patients diagnosed with dilated cardiomyopathy and HF.
- To examine the association between iron laboratory measurements and clinical characteristics or outcomes in this cohort.
- To determine if FeD correlates with HF severity and mortality in children.
Main Methods:
- A retrospective analysis of 28 pediatric patients (<21 years) with dilated cardiomyopathy and HF was conducted.
- Iron status was assessed using serum iron, iron saturation, and ferritin levels.
- Associations between iron parameters, echocardiographic findings, hospitalization, medication use, HF stage, and mortality were analyzed.
Main Results:
- A high prevalence of FeD was observed, with 96.4% of patients meeting the criteria.
- Low serum iron and iron saturation were significantly associated with increased HF severity (inpatient hospitalization, inotropic use, stage D HF).
- Low serum iron correlated with adverse echocardiographic findings, and low ferritin was linked to higher mortality.
Conclusions:
- Iron deficiency is common in pediatric patients with heart failure, particularly those with advanced disease.
- Abnormalities in iron profiles are associated with indicators of more severe heart failure and poorer outcomes, including mortality.
- These findings suggest a potential role for iron replacement therapy in managing pediatric heart failure.
Abstract:
Iron deficiency (FeD), with or without anemia, in adults with heart failure (HF) is associated with poor outcomes, which can be improved with replacement therapy. A similar therapeutic opportunity may exist for children; however, iron laboratory measurements and FeD have not been described in pediatric patients with HF. A single-center, retrospective study was conducted on 28 patients <21 years old with a diagnosis of dilated cardiomyopathy and HF who had iron laboratories (serum iron, iron saturation, and ferritin) performed. The mean (standard deviation) age at time of laboratory collection was 10.3 (5.5) years. Twenty-seven patients (96.4%) met the criteria for FeD. Serum iron and iron saturation were significantly associated with inpatient hospitalization, being on inotropic medications, or having stage D HF. Low-serum iron was associated with a higher left ventricular end-diastolic dimension and left ventricular end-systolic dimension z-score by echocardiography ((β -2.58, 95% confidence interval [CI] -4.76, -0.40, p = 0.02) and (β -2.43, 95% CI -4.70, -0.17, p = 0.04)), respectively. Low ferritin was associated with higher mortality (relative risk 0.29, 95% CI 0.12, 0.70, p = 0.006). In conclusion, FeD was common in this pediatric cohort with more advanced HF. Iron profile abnormalities were associated with worse HF severity and outcomes including mortality.
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