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Iron deficiency in pulmonary arterial hypertension associated with congenital heart disease
1a Center for Pulmonary Vascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases , Chinese Academy of Medical Sciences and Peking Union Medical College , Beijing , China.
Insights
Iron deficiency (ID) is common in congenital heart disease with pulmonary arterial hypertension (CHD-PAH), affecting 39% of patients. ID is linked to poorer exercise capacity and right heart function in these individuals.
Area of Science:
- Cardiology
- Pulmonology
- Hematology
Background:
- Congenital heart disease associated with pulmonary arterial hypertension (CHD-PAH) is a complex condition.
- Iron deficiency (ID) is increasingly recognized as a potential comorbidity in various cardiovascular diseases.
- The prevalence and impact of ID specifically in CHD-PAH patients require further investigation.
Purpose of the Study:
- To determine the prevalence of iron deficiency (ID) in patients diagnosed with congenital heart disease and pulmonary arterial hypertension (CHD-PAH).
- To explore the clinical implications and associations of ID in the CHD-PAH population.
- To identify factors associated with the presence of ID in CHD-PAH patients.
Main Methods:
- A cohort of 153 newly diagnosed CHD-PAH patients was studied.
- Patients were classified as iron-deficient or iron-replete based on transferrin saturation levels.
- Clinical data were collected, and logistic regression analysis was used to identify associated factors.
Main Results:
- Iron deficiency (ID) was identified in 39% of the 153 CHD-PAH patients.
- Iron-deficient patients exhibited a higher proportion of females, reduced 6-minute walking distance (6-MWD), elevated N-terminal pro-brain natriuretic peptide, and lower creatinine levels.
- Female sex, lower 6-MWD, and higher mean right atrial pressure were independently associated with ID in the overall cohort. Menstruation was associated with ID in females.
Conclusions:
- Iron deficiency (ID) is highly prevalent in patients with congenital heart disease and pulmonary arterial hypertension (CHD-PAH).
- ID is associated with worse exercise tolerance and impaired right heart function in CHD-PAH patients.
- Female sex, 6-MWD, mean right atrial pressure, and menstruation are key indicators for ID in this patient group.
Objectives:
We aimed to investigate the prevalence of iron deficiency (ID) in congenital heart disease associated with pulmonary arterial hypertension (CHD-PAH) and to explore the influence of ID on CHD-PAH patients. What was associated with ID in these patients was also looked into.
Design:
One hundred and fifty-three patients who were newly diagnosed with CHD-PAH were enrolled. Patients were divided into iron-deficient and iron-replete groups according to the following criteria. ID was defined as transferrin saturation <20% in male and transferrin saturation <25% in female. Clinical data of all participants were collected and compared. Logistic regression was performed to explore factors associated with ID in CHD-PAH.
Results:
Thirty-nine percent of 153 CHD-PAH patients were founded with ID. Iron-deficient group had greater proportion of female patients, shorter six minutes walking distance (6-MWD), higher N-terminal pro-brain natriuretic peptide levels, lower creatinine levels, greater ratio of diastolic right ventricle diameter to left ventricle diameter. Female (OR = 15.44, 95%CI 4.91-48.54, p < .01), 6-MWD (OR = 0.99, 95%CI 0.98-1.00, p = .02) and mean right atrial pressure (OR = 1.13, 95%CI 1.02-1.26, p = .02) were independently associated with ID in the overall CHD-PAH patients. Menstruation was independently associated with ID in the female subgroup (OR = 3.88, 95%CI 1.09-13.84, p = .04).
Conclusions:
ID was highly prevalent in CHD-PAH patients. Worse exercise tolerance and right heart function were observed in iron-deficient patients with CHD-PAH. Female, 6-MWD, mean right atrial pressure and menstruation are important variables indicating the presence of ID in CHD-PAH.
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