Iron Deficiency: A Silent Threat in Patients With Heart Failure With Reduced Ejection Fraction

Background Iron deficiency is a prevalent and clinically significant comorbidity in patients with heart failure with reduced ejection fraction (HFrEF). Despite its high prevalence, its impact on clinical outcomes, mortality, and various physiological parameters remains a subject of ongoing investigation. The findings of this study are anticipated to contribute valuable insights into the management and prognosis of patients with HFrEF, potentially informing future interventions and improving patient outcomes. This study aimed to assess the clinical profile of iron deficiency and its implications on morbidity and mortality in patients with HFrEF. Methodology A prospective cohort study was conducted at King Edward Memorial Hospital, India, involving 371 patients with HFrEF. Participants underwent comprehensive clinical and laboratory assessments, evaluating iron deficiency with signs, symptoms, comorbidities, dyspnea, elevated jugular venous pressure (JVP), past medical history, and various hematological and biochemical parameters. Results Overall, 50% of HFrEF participants were iron deficient (n = 185), of whom 80% (n = 148) had anemia against 43% (n = 81) anemics in iron repletes (n = 186). Of the 185 iron-deficient patients, 44 (11.86%) had absolute iron deficiency and 141 (38%) had functional iron deficiency. Iron deficiency significantly correlated with increased mortality in HFrEF patients (χ2 (1, N = 371) = 3.88, p = 0.048). A large positive correlation was observed between absolute iron deficiency and dyspnea severity (r2 = 0.949, p = 0.026). Statistically significant differences were found in hemoglobin (anemia), serum iron, serum ferritin, total iron-binding capacity, and transferrin saturation between iron-deficient and iron-replete patients (p < 0.05). However, no statistically significant difference in left ventricular ejection fraction between iron-deficient and replete patients was noted. Conclusions Iron deficiency emerges as more than a mere comorbidity in heart failure, becoming a prognostic factor with multifaceted outcomes. Its impact extends beyond cardiovascular consequences, encompassing adverse manifestations such as anemia, ascites, edema, dyspnea, elevated JVP, and a heightened risk of mortality. This intricate interplay positions iron deficiency as a critical determinant, significantly influencing the clinical trajectory and outcomes for patients with HFrEF.

A Clinical Profile of Patients with Hyperuricemia and the Relationship between Hyperuricemia and Metabolic Syndrome: A Cross-sectional Study at a Tertiary Hospital in the Indian Population

INTRODUCTION

Metabolic syndrome is a constellation of interrelated risk factors that increase the risk of cardiovascular diseases (CVD) and diabetes mellitus. The increase in prevalence of hyperuricemia was considered to be directly related to increasing incidence of obesity and Metabolic Syndrome in developing and developed countries. Hyperuricemia is defined as serum uric acid of 6.0mg/dl and 7.0mg/dl for females and males respectively.

AIMS AND OBJECTIVES

To study correlation of hyperuricemia with metabolic syndrome or its components.

MATERIALS AND METHODS

An observational, cross sectional single centre study with 316 patients fulfilling inclusion and exclusion criteria was carried out.

RESULTS

Out of 316 patients, 202 (63.9%) were males and 114 (36.1%) were females. 138(43.7%) were from rural areas and 178 (56.3%) were from urban areas. 126 (39.9%) patients had an active lifestyle and 190 (60.1%) had a sedentary lifestyle. Mean waist circumference among114 females was 82.10 cm and among men was 87.07cm. 113 patients fulfilled the criteria for central obesity with the mean uric acid level of 8.14 mg/dl (p=0.001); Mean uric acid level of patients without central obesity was 7.36 mg/dl. 99 (31.33%) fulfilled the criteria for hypertriglyceridemia with mean s.uric acid level 8.24mg/dl (p=0.0440). 124 had elevated blood pressure with mean s.uric acid 8.28 mg/dl (p=0.004). Patients with normal blood pressure had a mean value of s. uric acid 7.86 mg/dl. 33.44% fulfilled the criteria for metabolic syndrome (41.23%of total females and 32.10% of total males). Odds ratio was 1.28 and 0.864 for females and males respectively.

CONCLUSION

Prevalence of metabolic syndrome in patients with hyperuricemia was 35.4%. More common in females than males. Hyperuricemia is more prevalent in patients with a sedentary lifestyle. Hyperuricemia positively correlates with central obesity, blood pressure, hypertriglyceridemia and hyperglycemia. Hence, it is of utmost importance to screen patients of hyperuricemia for metabolic syndrome or its components to prevent mortality and morbidity associated with CVDs.

Hypervitaminosis D and Cortical Venous Thrombosis; An Unusual Presentation

Hypervitaminosis D is rare but potentially serious condition. It occurs most commonly due to excess doses of vitamin D supplementation, most commonly intramuscular. Here we report a case of iatrogenic hypervitaminosis D who presented with altered sensorium, cortical venous thrombosis and acute renal failure.

Isolated Subclavian Artery Thrombosis

We presume this case to highlight the importance of underestimated percutaneous angioplasty with stent in isolated subclavian artery thrombosis.