Related Experiment Video
Updated: May 5, 2026
Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
Published on: June 10, 2025
Association of blood essential and non-essential element levels with echocardiographic parameters among Saudi heart
Samah F Ibrahim1, Maha A Al-Mohaissen1, Terry Lee2
1Department of Internal Medicine, College of Medicine, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia.
Insights
Essential minerals like manganese (Mn), iron (Fe), and zinc (Zn) are vital for heart health, while toxic metals such as cadmium (Cd) and chromium (Cr) can worsen heart failure (HF). This study found associations between altered Cd and Mn levels and HF severity markers.
Area of Science:
- Cardiovascular Medicine
- Environmental Health
- Clinical Chemistry
Background:
- Essential elements (manganese, iron, zinc) are crucial for cardiovascular function.
- Exposure to toxic metals (cadmium, chromium) may contribute to cardiac dysfunction and heart failure (HF).
Purpose of the Study:
- To evaluate blood levels of manganese (Mn), iron (Fe), zinc (Zn), cadmium (Cd), and chromium (Cr) in Saudi patients with HF.
- To explore associations between these element levels and HF status, functional class, and echocardiographic parameters.
Main Methods:
- Blood samples from 180 adult patients (65.6% with HF) and controls were analyzed for Mn, Fe, Zn, Cd, and Cr using atomic absorption spectrophotometry.
- Clinical data and echocardiograms were collected and reviewed.
Main Results:
- Manganese levels were below reference range in 98% of participants.
- Higher cadmium (Cd) levels correlated with increased left ventricular dilatation.
- Higher chromium (Cr) levels were observed in younger participants.
Conclusions:
- Blood levels of manganese (Mn), iron (Fe), zinc (Zn), cadmium (Cd), and chromium (Cr) were assessed in relation to heart failure (HF) severity.
- Altered Cd and Mn blood levels were associated with specific echocardiographic markers of HF.
- Further research is needed to determine the prognostic value of element imbalances in HF.
Background:
Essential elements such as manganese (Mn), iron (Fe), and zinc (Zn) are critical in for cardiovascular function, whereas exposure to non-essential toxic metals, including cadmium (Cd) and chromium (Cr) may contribute to cardiac dysfunction and the development or progression of heart failure (HF).
Aim:
This study evaluated the blood levels of Mn, Fe, Zn, Cd, and Cr in adult Saudi patients with HF and in controls with normal ventricular function, and explored their associations with HF status, functional class, and echocardiographic parameters.
Methods:
Consecutive adult patients referred for clinically indicated transthoracic echocardiography at the outpatient department of King Fahad Medical City hospital between November 2019 and March 2020 were invited to participate. Clinical data were collected, echocardiograms were reviewed, and blood concentrations of of Mn, Fe, Zn, Cd, and Cr were measured using atomic absorption spectrophotometry.
Result:
A total of 180 participants were included (mean age 60.3 years), of whom 65.6% had HF. Most measured element levels were within reference ranges, except for Mn, which was below the reference range (<4 ug/L) in 98% of participants, with median (IQR) of 0.40 (0.30, 0.60). Higher Cr levels were observed among younger participants (P = 0.046). Higher Cd levels were associated with increased left ventricular dilatation (P = 0.013; P < 0.001 after adjusting for confounders). Conversly, higher Mn levels were associated with lower lateral mitral annular velocity in univariate analysis (P = 0.04), but this association was not retained after multivariable adjustment (P = 0.099).
Conclusion:
This study provides insight into Mn, Fe, Zn, Cd, and Cr concentrations across a spectrum of HF severity. Alteration in Cd and Mn blood levels were associated with selected echocardiographic markers of HF severity. Further longitudinal studies are needed to establish the prognostic significance of element imbalances in HF.
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:30Heart Failure IV: Classification and Diagnostic Evaluation
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:30Dysrhythmias V: Evaluating Dysrhythmias
01:17Pathophysiology of Heart Failure
01:29Heart Failure II: Pathophysiology