Iron metabolism parameters in patients with chronic heart failure and reduced left ventricular ejection fraction depending on basic demographic, clinical and instrumental characteristics

Main Article Content

L. G. Voronkov
V. V. Gorbachova
A. V. Lyashenko
T. I. Gavrilenko
L. S. Mhitaryan


The aim – to study the iron metabolism parameters in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (rLVEF) depending on main clinical characteristics of patients obtained during the instrumental study.
Material and methods. During period from January 2016 till February 2018, 134 stable patients with CHF (113 (84.3  %) of men and 21 (15.7 %) of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction
< 40 % were screened. Patients were included at a clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test (6MWT) and a standardized lower limb extension test.
Results and discussion. Iron deficiency was found in 83 (62 %) of 134 patients with CHF and rLVEF. There were no significant differences of iron metabolism in regard to CHF etiology and most co-morbidities. The presence of anemia was associated with lower ferritin, transferrin saturation (TSAT) and serum iron levels, and the presence of renal dysfunction – with the latter two. Patients in NYHA III–IV class had significantly lower TSAT and serum iron levels. The ferritin level was significantly higher only in group of patients with better muscular endurance, while TSAT and serum iron levels were also significantly higher in patients with greater 6-minutes walking distance, better hip muscles endurance, greater physical activity index and fewer scores by the Minnesota quality of life scale. Ferritin has shown a significant correlation with serum iron levels and hemoglobin. TSAT level correlated with a serum iron level, hemoglobin, limb muscles endurance, 6-minute walking test result, physical activity index and MLHFQ score.
Conclusions. Iron deficiency has been revealed in 62 % of patients with CHF and rLVEF. The plasma ferritin level is lower in patients with anemia and with worse muscle endurance. TSAT and serum iron levels are lower in patients with NYHA III–IV class, anemia, renal dysfunction, worse physical tolerance indicators and poorer quality of life. Both ferritin and TSAT demonstrate a relation to hemoglobin and iron plasma level, additionally TSAT – with physical activity index, 6-minutes walking test distance (6MWT), quadriceps femoris muscle endurance and MLHFQ quality of life.

Article Details


Heart failure, iron deficiency, iron, ferritin, transferrin saturation


Voronkov LG. Anemia in patients with CHF: how to evaluate and treat? Sertseva nedostatnist [Heart failure] 2015;2:5–12. (in Russ.).

Voronkov LH, Parashcheniuk LP, Yanovskyi HV.

Predictors of quality of life in patients with chronic heart failure of functional functional class III for NYHA. Sertse i sudyny [Heart and blood vessels] 2009;1:81–85. (in Ukr.).

Petri A, Sebin K. Visual statistics in medicine. K.: Geotar-med. 2003.143p. (in Russ.).

Rebrova OYu. Statistical analysis of medical data. Application software package Statistica. M.: Medisfera, 2002.305p. (in Russ.).

Recommendations of the Association of Cardiologists of Ukraine for Diagnostics and Health of Chronicle Heart Failure.К. 2017. (in Ukr.).

Recommendations of the workgroup with the functional diagnostics of the sociology of cardiology of Ukraine and the All-Ukrainian Association of Sociology with the echocardiography.– К. 2015.

Anker S.D., von Haehling S. Anaemia in chronic heart failure. 1st ed. Bremen: UNI-MED, 2009.

Arezes J, Nemeth E. Hepcidin and iron disorders: new biology and clinical approaches. Intern. J. Laboratory Hematology. 2015;37:92–98.

Chua A, Graham R, Trinder D, Olynyk J. The regulation of cellular iron metabolism. Crit. Rev. Clin. Lab. Sci. 2007;44:413–459.

Fitzsimons S, Doughty RN. Iron deficiency in patients with heart failure. Eur. Heart. J. 2015;1:58–64. DOI:10.1093ehjcvp/pvu016

Hlatky MA, Boineau RE, Higginbotham MB. A brief self-administrated questionnaire to determine functional capacity (The Duke Activity Status Index). Am. J. Cardiol. 1989;64:651–654.

Jankowska EA, Rozentryt P, Witkowska A, Nowak J, Hartmann O, Ponikowska B, Borodulin-Nadzieja L, Banasiak W, Polonski L, Filippatos G, McMurray JJ, Anker SD, Ponikowski P. Iron deficiency: an ominous sigh in patients with systolic chronic heart failure. Eur. Heart J. 2010;31:1872–1880. DOI: 10/1093/eurheart/ehq158.

Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur. Heart J. 2013;34:816–826. DOI 10.1093/eurheartj/ehs224

Jankowska EA, Malyszko J, Ardehali H, Koc-Zorawska E, Banasiak W, von Haehling S, Macdougall IC, Weiss G, McMurray JJ, Anker SD, Gheorghiade M, Ponikowski P. Iron status in patients with chronic heart failure. Eur. Heart J. 2013;34:827–834. DOI:10.1093/eurheartj/ehs37.

Jiang F, Sun ZZ, Tang YT, Xu C, Jiao XY. Hepcidin expression and iron parameters change in type 2 diabetic patients. Diabetes Res. Clin. Pract. 2011;93:43–48.

Kalra PR, Bolger AP, Francis DP, Genth-Zotz S, Sharma R, Ponikowski PP, Poole-Wilson PA, Coats AJ, Anker SD. Effect of anemia on exercise tolerance in chronic heart failure in men. Am. J. Cardiol. 2003;91:888–891.

Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, Lok DJ, Rosentryt P, Torrens A, Polonski L, van Veldhuisen DJ, van der Meer P, Jankowska EA. Iron deficiency in chronic heart failure: an international pooled analysis. Am. Heart J. 2013;165:575–582 e3. DOI: 10.1016/j.ahj.2013.01.017.

Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J; CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerularfiltration rate. Ann. Intern. Med. 2009;150:604–612.

Martinelli N, Traglia M, Campostrini N, Biino G, Corbella M, Sala C, Busti F, Masciullo C, Manna D, Previtali S, Castagna A, Pistis G, Olivieri O, Toniolo D, Camaschella C, Girelli D. Increased serum hepcidin levels in subjucts with the metabolic syndrome: a population study. PLoS One. 2012;7:e48–250.

Okonko D, Mandal A, Missouris C, Poole-Wilson P. Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and relation to anemia, exercise capacity, and survival. J. Am. Coll. Cardiol. 2011;58:1241–1251.

Rector TS, Kubo SH, Cohn JN. Patients sel-assessament of their congestive heart failure. Part 2: Content, reability and validity of a new measure, the Minnesota Living with Heart Failure Questionnaire. Heart Failure. 1987;3:198–207.

Vela D, Leshoski J, Vela Z, Jakupaj M, Mladenov M, Sopi RB. Insulin treatment corrects hepcidin but not YKL-40 levels in persons with type 2 diabetes mellitus matched by ody mass index, waist-to-height ratio, C-reactive protein and Creatinine. BMC Endocrine disorders. 2017. DOI 10.1186/s12902-017-0204-4.

WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity.Vitamin and Mineral Nutrition Information System.Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1). (

2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure.– 2016.DOI: 10.1002/ejhf.592

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