Association of trace element abnormalities and adverse outcomes in patients with acute heart failure

Trace elements, including zinc, copper, and selenium may influence heart failure prognosis due to their roles in mitochondrial function. Previous studies have reported associations between individual trace element abnormalities-such as low serum zinc, high serum copper, and low selenium levels-and adverse clinical outcomes, including reduced exercise capacity in patients with heart failure. However, the impact of multiple trace element abnormalities remains poorly understood. This study aimed to explore the prevalence of these abnormalities, both individually and in combination, and evaluate the association between multiple abnormalities and outcomes in patients with acute heart failure.

We analyzed patients with acute heart failure admitted to the Nagoya University Hospital between January 2012 and May 2024. Zinc, copper, and selenium levels were measured upon admission.

Among the 147 patients, 39 % had zinc deficiency, 52 % had copper excess, and 61 % had selenium deficiency. At least one trace element abnormality was observed in 84 % of patients, and two or three abnormalities were observed in 51 % of patients. Patients with multiple abnormalities had lower albumin levels, higher C-reactive protein levels, and lower hemoglobin levels than those without multiple abnormalities. Over a median follow-up of 196 days, all-cause death was more frequently observed in patients with two or three abnormalities than those with zero or one abnormality (adjusted hazard ratio, 3.78, 95 % confidence interval, 1.23-11.6).

Multiple trace element abnormalities are common in patients with acute heart failure and are associated with poor clinical outcomes. These findings suggest correcting trace element abnormalities may be a potential target in heart failure management.