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Iron Metabolic Alterations in Chronic Heart Failure

2012; Elsevier BV; Volume: 18; Issue: 8 Linguagem: Inglês

10.1016/j.cardfail.2012.06.370

1532-8414

Jaqueline R.S. Gentil, Vívian Marques Miguel Suen, Pedro Vellosa Schwartzmann, Fabiana Marques, Angela R. Silva, Júlio Sérgio Marchini, Marcus Vinícius Simões,

Iron Metabolism and Disorders

Iron deficiency (ID) is a marker of poor prognosis and several mechanisms may impair iron homeostasis in heart failure (HF), producing different forms of presentation of ID. We aim to highlight the distinct iron status and its biochemical parameters in HF. We evaluated clinical aspects and iron indexes of 108 patients in a HF Clinic. ID was defined as ferritin<100ng/dL or ferritin 100-300ng/dL with TSAT<20%; and it was characterized as absolute deficiency (TSAT<20%, ferritin<100ng/dL), functional deficiency (TSAT<20%) or depleted iron stores (ferritin<100ng/dL). Anemia was determined as Hb <13g/dL for men and <12g/dL for women. Anemia of chronic disease (ACD) was defined by the presence of normal TSAT and iron stores and absolute iron deficient anemia when both parameters were low. Differences between mean values were tested with Student t test or Mann-Whitney U test. The heterogeneity of frequency distribution was assessed by Fisher's exact test. Significance level was established at p 5020-50>2020-50<20 300>300100-300<100≥100<100Presence of anemia-41%17%35%60%57% Open table in a new tab ID was diagnosed in 50 patients (46%), with mean age higher than iron replete patients (p<0.01), 63±13 and 56±14years, respectively. They were similar in respect to gender, etiology of HF, comorbidities, left ventricular fraction ejection and hospitalization. However, 48% of iron deficient patients had functional class III/IV against 24% of iron replete (p<0.01; RR: 1.9). Depleted iron was also related to higher rate of anemia (p<0.01; RR: 1.8), lower creatinine clearance (p<0.05), higher serum urea values (p<0.05) and use of anticoagulant drugs. Among the 40 patients with anemia, 67% of then had some degree of ID. Absolute ID was present in 30% of anemic patients. ACD was identified in 15% of subjects with anemia. Iron disorders are highly prevalent in HF and have distinct forms. The diagnosis of ID was related to aging, more advanced functional class, anemia, kidney dysfunction and anticoagulant use.