Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients.

Abstract

BACKGROUND:

The most commonly used definition of iron deficiency (ID; ferritin <100 ng/mL or ferritin 100-300 ng/mL and transferrin saturation [TSAT] <20%) has not been validated in patients with heart failure (HF). We aimed to define and validate the biomarker-based definition of ID in HF, using bone marrow iron staining as the gold standard. Second, we aimed to assess the prognostic value of the optimized definition.

METHODS AND RESULTS:

Bone marrow aspiration with iron staining was performed in 42 patients with HF and a reduced left ventricular ejection fraction (≤45%) undergoing median sternotomy for coronary artery bypass grafting. Patients were mostly male (76%) with mild-to-moderate HF and a mean age of 68±10 years. Bone marrow ID was found in 17 (40%) of the HF patients. The most commonly used definition of ID had a sensitivity of 82% and a specificity of 72%. A definition solely based on TSAT ≤19.8% or serum iron ≤13 µmol/L had a sensitivity of 94% and specificity of 84% and 88%, respectively (P<0.05 compared with the former definition). Subsequently, we assessed the incidence of all-cause mortality in 387 consecutive outpatient HF patients (left ventricular ejection fraction ≤45%). In these patients, TSAT ≤19.8% and serum iron ≤13 µmol/L, and not ferritin, were independently associated with mortality.

CONCLUSIONS:

A TSAT ≤19.8% or a serum iron ≤13 µmol/L shows the best performance in selecting patients with ID and identifies HF patients at the highest risk of death. Our findings validate the currently used TSAT cutoff of <20% for the identification of ID in HF patients, but question the diagnostic value of ferritin.

• Authors: Niels Grote Beverborg, IJsbrand T Klip, Wouter C Meijers, Adriaan A Voors, Eline L Vegter, Haye H van der Wal, Dorine W Swinkels, Joost van Pelt, Andre B Mulder, Sjoerd K Bulstra, Edo Vellenga, Massimo A Mariani, Rudolf A de Boer, Dirk J van Veldhuisen, Peter van der Meer
• Journal: Circulation. Heart failure (Circ Heart Fail) Vol. 11 Issue 2 Pg. e004519 (02 2018) ISSN: 1941-3297 [Electronic] United States
• PMID: 29382661 (Publication Type: Journal Article)
• Copyright: © 2018 American Heart Association, Inc.

Chemical References

• Biomarkers
• Iron Compounds
• Ferritins

Topics

• Aged
• Aged, 80 and over
• Anemia, Iron-Deficiency (blood)
• Biomarkers (blood)
• Bone Marrow (pathology)
• Female
• Ferritins (blood)
• Heart Failure (diagnosis, pathology, physiopathology)
• Humans
• Iron Compounds (pharmacology)
• Iron Deficiencies
• Male
• Middle Aged
• Prognosis
• Staining and Labeling (methods)
• Ventricular Function, Left (physiology)