Iron deficiency: an ominous sign in patients with systolic chronic heart failure.

Jankowska EA, Rozentryt P, Witkowska A, et al.
Eur Heart J 2010;31(15):1872-1880.
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Review by : A. Maniatis
NATA Review

In this prospective observational study, Jankowska and colleagues evaluated and followed 546 patients with stable systolic chronic heart failure (CHF) and NYHA class I-IV, for the effect of iron deficiency on survival.

Iron deficiency was defined as ferritin < 100 μg or 100-300 g if TSAT was < 20%. The prevalence of iron deficiency was 57% in subjects with and 32% in those without anemia. It was more prominent in women and in patients in the advanced NYHA class. Patients were followed for more than 12 months and those surviving for 3 years. At the end of follow-up, there were 153 deaths (28%), and 30 heart transplantations. Iron deficiency, but not anemia, was related to an increased risk of death or transplantation in multivariable models. Anemia is well recognized as a risk factor in CHF. Iron deficiency per se, however, although known to affect functional capacity and quality of life in these patients, has not been previously shown to affect patient survival. This is a well-conducted study with a large number of subjects and long follow-up. Both univariate and multivariable analyses confirmed the detrimental effect of iron deficiency in patients with stable systolic CHF. This study suggests, provided results are confirmed by further studies, that iron status in CHF patients should be evaluated and iron deficiency should be corrected. – Alice Maniatis