scholarly journals Prevalence and pattern of Iron deficiency in patient with heart failure with reduced ejection fraction

2019 ◽  
Vol 7 (2) ◽  
pp. 10-16
Author(s):  
Aditya Mahaseth ◽  
Jay Narayan Shah ◽  
Bikash Nepal ◽  
Biplave Karki ◽  
Jeet Ghimire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Serum Ferritin ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Functional Iron Deficiency ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Absolute Iron Deficiency

Background and Objectives: Iron Deficiency is the commonest nutritional deficiency worldwide, affecting more than one-third of the population, its association with Heart Failure with or without anemia is of growing interest. As iron supplementation improves prognosis in patients with Heart Failure, Iron Deficiency is an attractive therapeutic target – a hypothesis that has recently been tested in clinical studies. This study is designed to estimate the prevalence and pattern of iron deficiency (ID) in heart failure (HF) with reduced ejection fraction patients with or without anemia. Material and methods: It was a single center hospital based cross sectional observational study. A total of 60 male and female patients with diagnosis of heart failure based on the Framingham Criteria, who gave consent for the study were included. They underwent laboratory evaluation including hemoglobin concentration, serum iron, transferrin saturation percentage, serum ferritin, total iron binding capacity. Serum ferritin <100 μg/l was used to diagnose absolute ID. Functional ID was defined as a serum ferritin level of 100–300 μg/l and a transferrin saturation of <20 %. Anemia was defined as hemoglobin (Hb) <13 g/dl for males and <12 g/dl for females, based on World Health Organization definition. Results: Using the above definitions iron deficiency was found in 28 (46.67%) patients. 36.67% patients had absolute iron deficiency and 10% patients had functional iron deficiency. Females had a higher non statistically significant iron deficiency than males 63.16% vs 39.02%. 15 patients (48.38%) with iron deficiency did not have anemia, and 11 (35.5%) of those patients had absolute iron deficiency. Conclusion: Iron deficiency is prevalent in patients with heart failure and reduced ejection fraction irrespective of anemia and hemoglobin levels. Many of those patients can have functional iron deficiency. Measurement of iron status should be a routine during workup of heart failure patients and further studies are needed to determine the prognostic value of iron status measurement and the influences of treatment of iron deficiency in heart failure patients. Many such trials are now underway.  

scholarly journals Pediatric Heart Failure: Cardiac Ejection Fraction with Cardiomyopathy Decreased to 21% in Iron Deficient from 37% in Iron Sufficient Children

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3077-3077
Author(s):  
Lia Phillips ◽  
Marc Richmond ◽  
Cindy Neunert ◽  
Gary M. Brittenham
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Iron Status ◽  
Transferrin Saturation ◽  
Iron Deficient ◽  
Patients With Heart Failure ◽  
Iv Iron ◽  
Cardiac Ejection Fraction ◽  
Absolute Iron Deficiency

Abstract Introduction: The overall aim of our study was to determine if iron deficiency has harmful effects on cardiac function in children with chronic heart failure. Heart failure in children is a complex, heterogeneous disorder leading to a final common pathway of cardiomyocyte dysfunction and attrition. Cellular, animal, and human studies have shown that iron deficiency causes cardiomyocyte dysfunction that can be reversed with iron treatment. Cellular studies of human iron-deficient cardiomyocytes have shown that supplemental iron restores impaired contractility and relaxation. Animal studies have found that cardiomyocyte-specific deletions or alterations of critical iron proteins (transferrin receptor 1, hepcidin, ferroportin) produce cardiomyocyte iron deficiency (without anemia) and result in ultimately fatal cardiac dysfunction that can be rescued with intravenous (IV) iron. Over half of adults with chronic heart failure are iron deficient. Meta-analysis of small randomized clinical trials has shown that IV iron significantly reduces recurrent hospitalization, cardiovascular mortality, and all-cause mortality in iron deficient adults with heart failure. European Society of Cardiology, American College of Cardiology and American Heart Association guidelines recommend consideration of IV iron therapy for adult iron-deficient patients with heart failure. The prevalence and consequences of iron deficiency in children with heart failure have not been established. Previously, two small retrospective studies of children with heart failure have reported that 56% to 96% were iron deficient, with increased morbidity and mortality. The goals of our study of children with heart failure were to determine (i) how often iron status is assessed, (ii) the prevalence of iron deficiency, and (iii) the effects of iron deficiency on cardiac function in patients with cardiomyopathy. Methods: We retrospectively reviewed electronic medical records to identify pediatric patients ages 1-21 years old seen at Columbia University Irving Medical Center Pediatric Heart Failure clinic with absolute iron deficiency during 2010-2020. Heart failure was defined as presence of symptoms or systolic dysfunction by echocardiography. Patients were excluded with a history of heart transplant, isolated diastolic failure, or renal failure requiring dialysis. In adults with heart failure, a transferrin saturation &lt;20% has a sensitivity of 94% and a specificity of 84% in identifying absolute iron deficiency, as determined from a bone marrow aspirate, and iron stores were present in 100% of patients with a transferrin saturation ≥30% (Circ Heart Fail. 2018;11:e0045). In children with heart failure, we used these criteria to define absolute iron deficiency as a transferrin saturation &lt;20% and iron sufficiency as a transferrin saturation ≥30%. Patients with an intermediate transferrin saturation are likely a mixture of absolute and functional iron deficiency, and of iron sufficiency and were excluded from our analysis of cardiomyopathy. Cardiac ejection fraction was evaluated by an echocardiogram performed within 3 months of measurement of transferrin saturation. Results: Of 579 patients with heart failure, only 159 (27%) had any type of laboratory iron studies. Of patients with iron studies, 81 (51%) were evaluated as outpatients; 49% as inpatients. The cause of heart failure was cardiomyopathy (52%), congenital heart disease (34%), acute myocarditis (6%), and other (8%). In the 82 patients with heart failure due to cardiomyopathy, 39 (48%) were iron deficient and 16 (20%) iron sufficient. In the iron deficient children with cardiomyopathy, the left ventricular ejection fraction was lower than in the iron sufficient patients (median 21% vs. 37%; p=0.03 (Mann-Whitney); Figure). The groups did not differ significantly with respect to hemoglobin (Figure), sex, age, or New York Heart Association class. Conclusion: We report a clinically important decrease in cardiac ejection fraction in children with heart failure due to cardiomyopathy who have absolute iron deficiency. Potentially, iron treatment could safely and effectively reverse the harmful effect of iron deficiency on heart function and prospective randomized trials of oral and intravenous iron therapy are urgently needed. Measurement of iron status should routinely be included in the evaluation of children with heart failure. Figure 1 Figure 1. Disclosures Neunert: Novartis: Research Funding.

scholarly journals IRON DEFICIENCY IN HEART FAILURE

2020 ◽  
Vol 4 (3) ◽  
Author(s):  
Kulbhushan Badyal ◽  
Shivani Panhotra
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Serum Ferritin ◽  
Binding Capacity ◽  
Iron Status ◽  
Nyha Class ◽  
Tertiary Care ◽  
Transferrin Saturation ◽  
Tertiary Care Centre

Background: Data on the burden of Iron deficiency (ID) in Heart failure (HF) patients in India are sparse and there is very little information available about the prevalence of iron deficiency in heart failure with mid-range (HFmrEF) and preserved ejection fraction (HFpEF) in comparison to heart failure with reduced ejection-fraction (HFrEF). Aims and Objective: This study was carried out with aim to evaluate iron profile in HF patients and to know the prevalence of ID in HFpEF, HFmrEF and HFrEF in our region. Materials and Methods: Patients with clinically diagnosed HF were enrolled in the study. This was a single tertiary care centre, prospective, observational study carried out from December 2017 to November 2018. Patients were classified into HFrEF, HFmrEF and HFpEF on echocardiography. Serum ferritin (micrograms per liter), serum iron (micrograms per liter), total iron binding capacity (micrograms per liter), transferrin (milligrams per deciliter), and transferrin saturation were measured to assess iron status. Absolute ID was defined as serum ferritin < 100 mg/L and functional ID was defined as normal serum ferritin (100–300 mg/L) with low TSAT (<20%). Results: A total of 120 patients of HF (66.7% males and 33.3% females) were studied. Out of 120 patients, 78 (65%) patients of HF had ID. Absolute ID was in 38.3% and functional ID was seen in 26.7% patients. 62.5% of males had ID, whereas, 70% of females had ID in HF. Patients with ID had higher NYHA Class, 35.9% compared to 23.8% patients without ID. ID was high in all subsets of HF. ID was found in 61.11% in HFrEF, 67.44% in HFmrEF and 69.57% in HFpEF. P-0.71. 14.1% patients had ID, but no anemia (p- 0.02). In anemic patients, ID was more (85.2%) than non anemic patients (69%). Conclusion: In our study, prevalence of ID was higher in patients of HF than that reported from western literature. HFpEF had higher prevalence of ID followed by HFmrEF and HFrEF, respectively. Literature is scanty about HFmrEF, our study has given an insight of ID in this subset of HF. ID can occur even without anemia and females are more prone to have ID in HF. Our study highlights the importance of diagnosis and treatment of ID in all subsets of HF, in order to improve quality of life, morbidity and mortality in patients of HF. Keywords: Iron deficiency, Heart Failure, Anemia, HFrEF, HFmrEF, HFpEF

scholarly journals Monitoring of iron status in patients with heart failure

2019 ◽  
Vol 21 (Supplement_M) ◽  
pp. M32-M35 ◽  
Author(s):  
Ewa A Jankowska ◽  
Michał Tkaczyszyn ◽  
Marcin Drozd ◽  
Piotr Ponikowski
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Serum Ferritin Level ◽  
Iron Status ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
Intravenous Iron ◽  
Accurate Method ◽  
Separate Entity ◽  
Patients With Heart Failure

Abstract The 2016 ESC/HFA heart failure (HF) guidelines emphasize the importance of identifying and treating iron deficiency (ID) in patients with HF. Iron deficiency can occur in half or more of HF sufferers, depending on age and the phase of the disease. Iron deficiency can be a cause of anaemia, but it is also common even without anaemia, meaning that ID is a separate entity, which should be screened for within the HF population. Although assessment of iron stores in bone marrow samples is the most accurate method to investigate iron status, it is not practical in most HF patients. Levels of circulating iron biomarkers are an easily available alternative; especially, ferritin and transferrin saturation (Tsat). In patients with HF serum ferritin level &lt;100 µg/L (regardless of Tsat value) or between 100 and 299 µg/L with Tsat &lt;20% are considered as recommended criteria for the diagnosis of ID, criteria which have been used in the clinical trials in HF that have led to a recommendation to treat ID with intravenous iron. We discuss the optimal measures of iron biomarkers in patients with HF in order to screen and monitor iron status and introduce some novel ways to assess iron status.

scholarly journals Iron deficiency in heart failure with preserved ejection fraction: a systematic review and meta-analysis

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001012 ◽  
Author(s):  
Anna L Beale ◽  
Josephine Lillian Warren ◽  
Nia Roberts ◽  
Philippe Meyer ◽  
Nick P Townsend ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Meta Analysis ◽  
Conclusive Evidence ◽  
Preserved Ejection Fraction ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Related Quality ◽  
Health Related

ObjectiveIron deficiency (ID) has an established impact on outcomes in patients with heart failure with reduced ejection fraction; however, there is a lack of conclusive evidence in patients with heart failure with preserved ejection fraction (HFpEF). We sought to clarify the prevalence and impact of ID in patients with HFpEF.MethodsA systematic search of Cohcrane, MEDLINE, EMBASE, Web of Science and CINAHL electronic databases was performed to identify relevant studies. Included studies defined HFpEF as heart failure with an ejection fraction ≥50%. We used a random-effects meta-analysis to determine the composite prevalence of ID in patients with HFpEF across the included studies. Other outcomes were assessed with qualitative analysis due to a paucity of studies with comparable outcome measures.ResultsThe prevalence of ID in the included studies was 59% (95% CI 52% to 65%). ID was associated with lower VO2 max in three of four studies reporting VO2 max as an outcome measure, lower functional status as determined by dyspnoea class or 6 min walk test in two of three studies, and worse health-related quality of life in both studies reporting on this outcome. Conversely, ID had no impact on death or hospitalisation in three of the four studies investigating this.ConclusionsID is highly prevalent in patients with HFpEF and is associated with worse exercise capacity and functional outcomes, but not hospitalisation or mortality. Our study establishes that ID may play an important a role in HFpEF.

Efficacy of a Low-Dose Intravenous Iron Sucrose Regimen in Peritoneal Dialysis Patients

2002 ◽  
Vol 22 (1) ◽  
pp. 60-66 ◽  
Author(s):  
Elisabeth Dittrich ◽  
Martin Schillinger ◽  
Gere Sunder–Plassmann ◽  
Walter H. Hörl ◽  
Andreas Vychytil
Keyword(s):  
Peritoneal Dialysis ◽  
Iron Deficiency ◽  
Serum Ferritin ◽  
Low Dose ◽  
Transferrin Saturation ◽  
Iron Sucrose ◽  
Dialysis Patients ◽  
Functional Iron Deficiency ◽  
Iv Iron ◽  
Absolute Iron Deficiency

Objective Sufficient iron substitution leads to a decrease in the required recombinant human erythropoietin (rHuEPO) dose and/or an increased hematocrit in dialysis patients. Intravenous (IV) application of larger doses of iron sucrose may be associated with hyperferritinemia, appearance of catalytically free iron, and impaired phagocyte function. Therefore, we investigated the effectiveness of a low-dose IV iron regimen in peritoneal dialysis (PD) patients. Patients and Interventions Forty-five PD patients were followed over a period of 1 year. Serum ferritin, serum transferrin saturation, and hemoglobin were measured monthly. In cases of absolute iron deficiency (serum ferritin < 100 μg/L), 50 mg iron sucrose was given IV every second week. In cases of functional iron deficiency (ferritin ≥ 100 μg/L and transferrin saturation < 20%) and in iron repleted patients (ferritin ≥ 100 μg/L and transferrin saturation ≥ 20%), 50 mg IV iron sucrose was applied monthly. Iron therapy was stopped in cases of acute infection (until complete recovery) and when serum ferritin level was ≥ 600 μg/L. Results To analyze the influence of iron substitution on erythropoiesis and rHuEPO requirements, the EPO resistance index (ERI; quotient of rHuEPO dose in units/kilogram/week and hemoglobin in grams per deciliter) was calculated every 3 months. The ERI decreased significantly during the course of the study in the whole patient group ( p = 0.009) as well as in the subgroup of 21 patients with absolute iron deficiency ( p = 0.01). A nonsignificant decrease in the ERI was observed within the group of 14 iron repleted patients ( p = 0.5). There was no significant change in the ERI in 10 patients with functional iron deficiency ( p = 0.6). Conclusion The low-dose IV iron regimen used in this study substantially decreased rHuEPO requirements in patients with absolute iron deficiency and was effective in maintaining iron stores in iron repleted patients. However, in the absence of significant hyperparathyroidism, aluminum toxicity, or inadequate dialysis, it did not improve the ERI in patients with functional iron deficiency.

scholarly journals FUNCTIONAL IRON DEFICIENCY IN HEART FAILURE WITH PRESERVED VERSUS REDUCED EJECTION FRACTION

2014 ◽  
Vol 63 (12) ◽  
pp. A778 ◽  
Author(s):  
Yeo Tee Joo ◽  
Poh Shuan Yeo ◽  
David Kheng Leng Sim ◽  
Kui toh Leong ◽  
Hean Yee Ong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Functional Iron Deficiency ◽  
Reduced Ejection Fraction

scholarly journals Iron Deficiency in Acute Decompensated Heart Failure

2019 ◽  
Vol 8 (10) ◽  
pp. 1569 ◽  
Author(s):  
Anna Beale ◽  
Davis Carballo ◽  
Jerome Stirnemann ◽  
Nicolas Garin ◽  
Thomas Agoritsas ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Acute Decompensated Heart Failure ◽  
Ferritin Level ◽  
Transferrin Saturation ◽  
Decompensated Heart Failure ◽  
Reduced Ejection Fraction ◽  
Tertiary Center ◽  
High Prevalence

The aim of this study was to characterize iron deficiency (ID) in acutely decompensated heart failure (ADHF) and identify whether ID is associated with dyspnea class, length of stay (LOS), biomarker levels, and echocardiographic indices of diastolic function in patients with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Consecutive patients admitted with ADHF at a single tertiary center were included. Demographic information, pathology investigations, and metrics regarding hospital stay and readmission were recorded. Patients were classified as having ‘absolute’ ID if they had a ferritin level <100 ng/mL; or ‘functional’ ID if they had a ferritin 100–200 ng/mL and a transferrin saturation <20%. Of 503 patients that were recruited, 270 (55%) had HFpEF, 160 (33%) had HFREF, and 57 (12%) had heart failure with mid-range ejection fraction. ID was present in 54% of patients with HFrEF and 56% of patients with HFpEF. In the HFpEF group, ID was associated with a LOS of 11 ± 7.7 vs. 9 ± 6 days in iron replete patients, p = 0.036, and remained an independent predictor of increased LOS in a multivariate linear regression incorporating comorbidities, age, and ID status. This study corroborates a high prevalence of ID in both HFrEF and HFpEF, and further shows that in patients with HFpEF there is a prolongation of LOS not seen in HFrEF which may indicate a more prominent role for ID in HFpEF.

scholarly journals Growth differentiation factor 15 predicts poor prognosis in patients with heart failure and reduced ejection fraction and anemia: results from RED-HF

2021 ◽  
Author(s):  
Thor Ueland ◽  
Lars Gullestad ◽  
Lei Kou ◽  
James B. Young ◽  
Marc A. Pfeffer ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Clinical Outcomes ◽  
Darbepoetin Alfa ◽  
Iron Status ◽  
Baseline Serum ◽  
Reduced Ejection Fraction ◽  
Patients With Heart Failure ◽  
Moderate Anemia

Abstract Aims We aimed to assess the value of GDF-15, a stress-responsive cytokine, in predicting clinical outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and anemia Methods and results Serum GDF-15 was assessed in 1582 HFrEF and mild-to-moderate anemia patients who where followed for 28 months in the Reduction of Events by Darbepoetin alfa in Heart Failure (RED-HF) trial, an overall neutral RCT evaluating the effect darbepoetin alfa on clinical outcomes in patients with systolic heart failure and mild-to-moderate anemia. Association between baseline and change in GDF-15 during 6 months follow-up and the primary composite outcome of all-cause death or HF hospitalization were evaluated in multivariable Cox-models adjusted for conventional clinical and biochemical risk factors. The adjusted risk for the primary outcome increased with (i) successive tertiles of baseline GDF-15 (tertile 3 HR 1.56 [1.23–1.98] p < 0.001) as well as with (ii) a 15% increase in GDF-15 levels over 6 months of follow-up (HR 1.68 [1.38–2.06] p < 0.001). Addition of change in GDF-15 to the fully adjusted model improved the C-statistics (p < 0.001). No interaction between treatment and baseline or change in GDF-15 on outcome was observed. GDF-15 was inversely associated with several indices of anemia and correlated positively with ferritin. Conclusions In patients with HF and anemia, both higher baseline serum GDF-15 levels and an increase in GDF-15 during follow-up, were associated with worse clinical outcomes. GDF-15 did not identify subgroups of patients who might benefit from correction of anemia but was associated with several indices of anemia and iron status in the HF patients. Graphic abstract

PT081 Functional iron deficiency in heart failure with preserved versus reduced ejection fraction

Global Heart ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e181 ◽  
Author(s):  
Tee Joo Yeo ◽  
Poh Shuan Daniel Yeo ◽  
David Sim ◽  
Gerard Kui Toh Leong ◽  
Hean Yee Ong ◽  
...  
Keyword(s):  
Heart Failure ◽  
Iron Deficiency ◽  
Ejection Fraction ◽  
Functional Iron Deficiency ◽  
Reduced Ejection Fraction
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