Impact of iron deficiency on exercise capacity and outcome in heart failure with reduced, mid-range and preserved ejection fraction.

Abstract

BACKGROUND:

Little information is available about the prevalence and impact on exercise capacity and outcome of iron deficiency in heart failure with mid-range (HFmrEF) and preserved (HFpEF) ejection fraction in comparison to heart failure with reduced ejection-fraction (HFrEF). Furthermore, no data is available about the progression of ID in patients without baseline anaemia.

METHODS:

We evaluated baseline iron and haemoglobin-status in a single-centre, prospective heart failure database. Baseline functional status, VO2max, echocardiography and clinical-outcome (all-cause mortality and heart failure admissions) were evaluated. ID, anaemia, HFrEF, HFmrEF and HFpEF were defined according to established criteria.

RESULTS:

A total of 1197 patients (71% male) were evaluated (HFrEF, n = 897; HFmrEF, n = 229; HFpEF, n = 72). The overall prevalence of ID was 53% (50% in HFrEF; 61% in HFmrEF; 64% in HFpEF) and 36% for anaemia. ID was associated with a lower VO2max in patients with HFrEF, HFmrEF and HFpEF (p < .001 in all). Iron status more closely related to a poor VO2max than anaemia status (p < .001). Furthermore, poor clinical-outcome was more strongly associated with iron status than anaemia status. Exposing eight patients without anaemia to iron deficiency for 39 months resulted in one patient developing new-onset anaemia (defined as progression of ID). Patients with progression of ID exhibited a significant higher risk of heart failure hospitalisation and all-cause mortality (HR = 1.4; CI = 1.01-1.94; p = .046) than patients without progression.

CONCLUSIONS:

Iron deficiency is common in patients with HFrEF, HFmrEF and HFpEF, and negatively affects VO2max and clinical-outcome. Progression of iron deficiency parallels an increased risk for worsening of heart failure.

• Authors: Pieter Martens, Petra Nijst, Frederik H Verbrugge, Kevin Smeets, Matthias Dupont, Wilfried Mullens
• Journal: Acta cardiologica (Acta Cardiol) Vol. 73 Issue 2 Pg. 115-123 (Apr 2018) ISSN: 0001-5385 [Print] England
• PMID: 28730869 (Publication Type: Journal Article, Observational Study)

Chemical References

• Hemoglobins
• Iron

Topics

• Aged
• Anemia, Iron-Deficiency (epidemiology, etiology, physiopathology)
• Belgium (epidemiology)
• Cause of Death (trends)
• Disease Progression
• Echocardiography
• Exercise Tolerance (physiology)
• Female
• Follow-Up Studies
• Heart Failure (complications, mortality, physiopathology)
• Heart Ventricles (diagnostic imaging, physiopathology)
• Hemoglobins (metabolism)
• Humans
• Iron (blood)
• Male
• Prevalence
• Prognosis
• Prospective Studies
• Registries
• Risk Factors
• Stroke Volume (physiology)
• Survival Rate (trends)