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Cohen-Solal A, Philip JL, Picard F, Delarche N, Taldir G, Gzara H, Korichi A, Trochu JN, Cacoub P. Iron deficiency in heart failure patients: the French CARENFER prospective study. ESC Heart Fail 2022; 9:874-884. [PMID: 35170249 PMCID: PMC8934919 DOI: 10.1002/ehf2.13850] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/08/2022] [Accepted: 02/07/2022] [Indexed: 12/15/2022] Open
Abstract
Aims Iron deficiency (ID) is reported as one of the main co‐morbidities in patients with chronic heart failure (CHF), which then influences quality of life and prognosis. The CARENFER study aimed to assess the prevalence of ID in a large panel of heart failure (HF) patients at different stages of the disease. Methods and results This prospective cross‐sectional nationwide study was conducted in 48 medical units in France in 2019. Serum ferritin concentration and transferrin saturation (TSAT) index were determined in all eligible patients with a diagnosis of HF. ID diagnosis was based on the European Society of Cardiology (ESC) 2016 guidelines. Patients were classified as having either a decompensated HF or a CHF. Left ventricular ejection fraction (LVEF) was categorized as preserved (≥50%), mildly reduced (40–49%), or reduced (<40%). ID diagnosis was determined in 1661 patients, of whom 1475 could be classified as having a decompensated HF or a CHF. Patients' median age was 78 years. Decompensated HF represented 60.1% of cases. The overall prevalence of ID was 49.6% (47.1–52.1). In CHF and decompensated HF patients, respectively, ID prevalence was 39.0% (35.1–43.1) and 58.1% (54.7–61.4), P < 0.001; TSAT < 20% was respectively reported in 34.7% and 70.0% of patients (P < 0.001). Patients with preserved LVEF were more likely to have an ID (57.5%) compared with patients with mildly reduced (47.4%) or reduced LVEF (44.3%) (P < 0.001). Conclusions Iron deficiency was highly prevalent in patients with decompensated HF or CHF with preserved LVEF. ID prevalence defined by TSAT was higher than by the ESC criteria in decompensated HF patients, questioning the importance of ID definition to assess its prevalence.
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Affiliation(s)
- Alain Cohen-Solal
- Department of Cardiology and Vascular Disease, Paris University, UMR-S 942 MASCOT, Lariboisière Hospital, Assistance Publique-Hôpitaux de Paris, 2 rue Ambroise Paré, Paris, 75010, France
| | - Jean-Luc Philip
- Intensive Care Unit in Cardiology, Chalon Hospital, Chalon, France
| | - François Picard
- Cardiology Unit, Hôpital du Haut Lévêque, University Hospital of Bordeaux, Bordeaux University, Pessac, France
| | | | - Guillaume Taldir
- Department of Cardiology, Saint-Brieuc Hospital, Saint Brieuc, France
| | - Heger Gzara
- Sud Francilien Hospital, Corbeil-Essonnes, France
| | | | - Jean-Noel Trochu
- Institut du Thorax, University Hospital of Nantes, University of Nantes, CNRS, INSERM, Nantes, France
| | - Patrice Cacoub
- Department of Internal Medicine and Clinical Immunology, Groupe Hospitalier Pitié-Salpêtrière, La Pitié Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, 83 Boulevard de l'Hôpital, Paris, 75651, France.,Inflammation-Immunopathology-Biotherapy Department (DHU i2B), UPMC Univ Paris 06, UMR 7211, INSERM, UMRS 959, Sorbonne Université, Paris, F-75005, France
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van Dalen DH, Kragten JA, Emans ME, van Ofwegen-Hanekamp CEE, Klaarwater CCR, Spanjers MHA, Hendrick R, van Deursen CTBM, Brunner-La Rocca HP. Acute heart failure and iron deficiency: a prospective, multicentre, observational study. ESC Heart Fail 2021; 9:398-407. [PMID: 34862747 PMCID: PMC8788059 DOI: 10.1002/ehf2.13737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023] Open
Abstract
Aims The prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter. Methods and results In this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin <100 μg/L = absolute ID or ferritin 100–299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2). At T0, ID was present in 71.8% of the patients (44.1% absolute and 27.7% functional ID). At T1 and T2, ID was present in 56.4% (32.4% absolute and 24% functional ID) and 50.3% (36.8% absolute and 13.5% functional ID), respectively. Absolute ID persisted from T0 to T2 in 66% of the patients, while functional ID resolved in 56% of the patients. Ferritin (median [interquartile range] 124 μg/L [56–247] to 150 μg/L [73–277]), transferrin saturation (15% [10–20] to 18% [12–27]), and iron levels (9 μmol/L [6–13] to 11 μmol/L [8–16]) increased significantly (all P < 0.001) from T0 to T1. Transferrin saturation (to 21% [15–29]) and iron levels (to 13 μmol/L [9–17]) also increased significantly (both P < 0.01) from T1 to T2 without iron supplementation. Conclusions Iron deficiency is highly prevalent in patients with AHF, but resolves during treatment in some patients, even without iron supplementation. Absolute ID is more likely to persist over time, whereas functional ID often resolves during treatment of AHF, representing probably a reduced iron availability rather than a true deficiency.
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Affiliation(s)
- Dirk H van Dalen
- Department of Cardiology, Jeroen Bosch Hospital, PO Box 90153, room B4.02.022, 's-Hertogenbosch, 5200ME, The Netherlands
| | - Johannes A Kragten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Mireille E Emans
- Department of Cardiology, Ikazia Hospital Rotterdam, Rotterdam, The Netherlands
| | | | | | - Mireille H A Spanjers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rémond Hendrick
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Cees Th B M van Deursen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,School of Cardiovascular Diseases (CARIM), University of Maastricht, Maastricht, The Netherlands
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Ying H, Shen Z, Wang J, Zhou B. Role of iron homeostasis in the heart : Heart failure, cardiomyopathy, and ischemia-reperfusion injury. Herz 2021; 47:141-149. [PMID: 33978777 DOI: 10.1007/s00059-021-05039-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/15/2020] [Accepted: 04/09/2021] [Indexed: 02/07/2023]
Abstract
As an essential trace mineral in mammals and the second most abundant metal in the Earth's crust, iron acts as a double-edged sword in humans. Iron plays important beneficial roles in numerous biological processes ranging from deoxyribonucleic acid biosynthesis and protein function to cell cycle progression. However, iron metabolism disruption leads to widespread tissue degeneration and organ dysfunction. An increasing number of studies have focused on iron regulation pathways and have explored the relationship between iron and cardiovascular diseases. Ferroptosis, an iron-dependent form of programmed cell death, was first described in cancer cells and has recently been linked to heart diseases, including cardiac ischemia-reperfusion injury and doxorubicin-induced myocardiopathy. Here, we summarize recent advances in our understanding of iron homeostasis and heart diseases and discuss potential relationships between ferroptosis and cardiac ischemia-reperfusion injury and cardiomyopathy.
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Affiliation(s)
- Hangying Ying
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Zhejiang, Hangzhou, China
| | - Zhida Shen
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Zhejiang, Hangzhou, China
| | - Jiacheng Wang
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Zhejiang, Hangzhou, China
| | - Binquan Zhou
- Department of Cardiology, Key Laboratory of Cardiovascular Intervention and Regenerative Medicine of Zhejiang Province, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 310016, Zhejiang, Hangzhou, China.
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Pezel T, Audureau E, Mansourati J, Baudry G, Ben Driss A, Durup F, Fertin M, Godreuil C, Jeanneteau J, Kloeckner M, Koukoui F, Kesri-Tartière L, Laperche T, Roubille F, Cohen-Solal A, Damy T. Diagnosis and Treatment of Iron Deficiency in Heart Failure: OFICSel study by the French Heart Failure Working Group. ESC Heart Fail 2021; 8:1509-1521. [PMID: 33619905 PMCID: PMC8006682 DOI: 10.1002/ehf2.13245] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/23/2021] [Indexed: 01/19/2023] Open
Abstract
AIMS Iron deficiency (ID) occurs in about 50% of patients with heart failure (HF). The European Society of Cardiology (ESC) recommends ID diagnostic testing in newly diagnosed patients with HF and during follow-up, with intravenous iron supplementation (IS) only recommended in patients with HF with reduced ejection fraction (HFrEF). This study aimed to assess prevalence, clinical characteristics, and application of ESC guidelines for ID and IS in patients with HF in the real-life clinical setting. METHODS AND RESULTS The French transversal multicentre OFICSel registry (300 cardiologists) conducted in 2017 included patients hospitalized for HF at least once in the previous 5 years. Diverse adult patients were eligible including inpatients and outpatients and those with acute and chronic HF. Data were collected from cardiologists and patients using study-specific surveys. Data included demographic and clinical data, as well as HF and ID management data. Overall, 2822 patients, mainly male (69.3%) with a median age of 69 years (interquartile range 58-78), were included. A total of 1075 patients (38.1%) were tested for ID, with 364 (33.9%) diagnosed. Of these, 168 (46.2%) received IS: 128 (76.2%) intravenous IS and 40 (23.8%) oral. Among the 201 patients with HFrEF diagnosed with ID, 99 (49.3%) received IS: 79 (79.8%) intravenous IS and 20 (20.2%) oral. CONCLUSIONS In clinical practice, only one-third of patients with HF had a diagnostic test for ID. In patients with ID with HFrEF, only 39.3% received intravenous IS as recommended. Thus, in general, cardiologists should be encouraged to follow the ESC guidelines to ensure optimal treatment for patients with HF.
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Affiliation(s)
- Theo Pezel
- Department of Cardiology, Centre Hospitalo-Universitaire (CHU) Lariboisière, AP-HP, 2 rue Ambroise Paré, Paris, 75010, France.,Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | | | - Guillaume Baudry
- Department of Cardiology, Heart Failure Unit, CH Louis Pradel, Bron, France
| | | | | | - Marie Fertin
- Department of Cardiology, CHRU Lille, Lille, France
| | - Christian Godreuil
- Service de Réadaptation Cardiovasculaire et Hôpital Médical de Jour, Hôpital d'Instruction des Armées Bégin, Saint-Mandé, France
| | | | - Martin Kloeckner
- Service de Cardiologie, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Le Plessis-Robinson, France
| | - François Koukoui
- Rehabilitation Center, CH Sud Francilien, Corbeil-Essonnes, France
| | | | - Thierry Laperche
- Department of Cardiology, Centre Cardiologique du Nord, Saint-Denis, France
| | - François Roubille
- PhyMedExp, Université de Montpellier, INSERM, CNRS, Department of Cardiology, CHU de Montpellier, Montpellier, France
| | - Alain Cohen-Solal
- Department of Cardiology, Centre Hospitalo-Universitaire (CHU) Lariboisière, AP-HP, 2 rue Ambroise Paré, Paris, 75010, France
| | - Thibaud Damy
- Department of Cardiology, Referral Centre for Cardiac Amyloidosis, CHU Henri Mondor, AP-HP, Créteil, France
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Marchi G, Busti F, Vianello A, Girelli D. Anemia and iron deficiency in heart failure: extending evidences from chronic to acute setting. Intern Emerg Med 2021; 16:167-170. [PMID: 32651940 DOI: 10.1007/s11739-020-02434-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 07/02/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Giacomo Marchi
- Section of Internal Medicine, Department of Medicine, EuroBloodNet Referral Center for Iron Disorders, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy.
| | - Fabiana Busti
- Section of Internal Medicine, Department of Medicine, EuroBloodNet Referral Center for Iron Disorders, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Vianello
- Section of Internal Medicine, Department of Medicine, EuroBloodNet Referral Center for Iron Disorders, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Domenico Girelli
- Section of Internal Medicine, Department of Medicine, EuroBloodNet Referral Center for Iron Disorders, University of Verona, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
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