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Accurate Noninvasive Assessment of Myocardial Iron Load in Advanced Heart Failure Patients
Przemysław Leszek1, Barbara Sochanowicz2, Kamil Brzóska2
1The National Cardinal Stefan Wyszynski Institute of Cardiology, 04-628 Warszawa, Alpejska 42, Poland.
Insights
Assessing myocardial iron (M-Iron) in heart failure (HF) patients is crucial. A novel serum marker ratio (sTfR1/logFR) can now predict M-Iron levels, improving iron repletion therapy safety.
Area of Science:
- Cardiology
- Biochemistry
- Medical Diagnostics
Background:
- Iron deficiency is common in heart failure (HF) patients, and while iron supplementation can help, iron overload poses a significant risk to the heart.
- Precisely balancing myocardial iron (M-Iron) is critical in HF patients, but direct assessment via biopsies or MRI is impractical.
- There is a need for reliable non-invasive serum markers to assess M-Iron levels in advanced HF.
Purpose of the Study:
- To assess M-Iron levels in patients with advanced HF.
- To investigate the association between M-Iron and various serum markers of iron metabolism.
- To identify a reliable serum marker for predicting M-Iron in HF patients.
Main Methods:
- Left ventricle myocardial biopsies and serum samples were collected from 33 HF patients undergoing heart transplantation.
- Myocardial ferritin (M-FR) and myocardial soluble transferrin receptor (M-sTfR1) were measured using ELISA.
- M-Iron was quantified using Instrumental Neutron Activation Analysis; serum FR and sTfR1 concentrations were also assessed.
Main Results:
- Myocardial iron load was reduced in HF patients and negatively correlated with myocardial ferritin (M-FR).
- The serum soluble transferrin receptor (sTfR1) to serum ferritin (FR) ratio (sTfR1/logFR) correlated with and predicted M-Iron levels.
- A formula was derived to calculate M-Iron load based on the sTfR1/logFR ratio.
Conclusions:
- The sTfR1/logFR ratio serves as a valuable predictor of left ventricle M-Iron levels.
- Serum FR and sTfR1 levels can be utilized for indirect assessment of M-Iron, enhancing the safety of iron repletion therapy in HF patients.
Background:
Heart failure patients presenting with iron deficiency can benefit from systemic iron supplementation; however, there is the potential for iron overload to occur, which can seriously damage the heart. Therefore, myocardial iron (M-Iron) content should be precisely balanced, especially in already failing hearts. Unfortunately, the assessment of M-Iron via repeated heart biopsies or magnetic resonance imaging is unrealistic, and alternative serum markers must be found. This study is aimed at assessing M-Iron in patients with advanced heart failure (HF) and its association with a range of serum markers of iron metabolism.
Methods:
Left ventricle (LV) myocardial biopsies and serum samples were collected from 33 consecutive HF patients (25 males) with LV dysfunction (LV ejection fraction 22 (11) %; NT-proBNP 5464 (3308) pg/ml) during heart transplantation. Myocardial ferritin (M-FR) and soluble transferrin receptor (M-sTfR1) were assessed by ELISA, and M-Iron was determined by Instrumental Neutron Activation Analysis in LV biopsies. Nonfailing hearts (n = 11) were used as control/reference tissue. Concentrations of serum iron-related proteins (FR and sTfR1) were assessed.
Results:
LV M-Iron load was reduced in all HF patients and negatively associated with M-FR (r = -0.37, p = 0.05). Of the serum markers, sTfR1/logFR correlated with (r = -0.42; p = 0.04) and predicted (in a step-wise analysis, R 2 = 0.18; p = 0.04) LV M-Iron. LV M-Iron load (μg/g) can be calculated using the following formula: 210.24-22.869 × sTfR1/logFR.
Conclusions:
The sTfR1/logFR ratio can be used to predict LV M-Iron levels. Therefore, serum FR and sTfR1 levels could be used to indirectly assess LV M-Iron, thereby increasing the safety of iron repletion therapy in HF patients.
