Clinical and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction without anemia, depending on the presence of iron deficiency
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Abstract
The aim – to compare patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) without anemia depending on the presence of iron deficiency (ID) according to the main clinical, hemodynamic, laboratory parameters and prognosis indicators.
Material and methods. In January – February, 2018, 95 stable patients with CHF (83 of men and 12 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included during 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 and a standardized lower limb extension test.
Results. ID was found in 51 out of 95 patients without anemia. Patients with ID without anemia were reliably in higher functional class, had a lower body mass index, lower systolic blood pressure, glomerular filtration rate, worse 6-minute walking test and thigh quadriceps endurance and a lower quality of life by MLHFQ. They also had lower hemoglobin, MCV, MCH, hepcidin levels and higher NT-proBNP, interleukin 6, and citrulline levels. The presence of ID, even without concomitant anemia, increased both risk of death from any cause and the combined critical event risk (death or hospitalization) during 12 and 24 months.
Conclusions. Among patients with CHF and reduced LVEF without anemia, ID was observed in 54 % of patients. Patients with ID were characterized by a greater proportion of patients in NYHA class III–IV and renal dysfunction, poorer functional capacity (6-minute walking test, thigh quadriceps endurance), poorer quality of life, lower body mass index, lower systolic blood pressure and lower hemoglobin and hepcidin levels along with higher circulating interleukin 6, citrulline and NT-proBNP levels. ID without concomitant anemia was associated with worse survival and more frequent hospitalizations.
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Mkhitarian LS, Kuchmenko OB, Yevstratova IN, Lipkan NH, Vasylynchuk NM, Drobotko TF. Citrulline as a marker of the functional state of organs under conditions of pathological conditions. Ukrainskyi kardiolohichnyi zhurnal [Ukrainian Journal of Cardiology] 2016;3:109–115. (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 the Diagnosis and Treatment of Chronic Heart Failure. К.,2017. (in Ukr.).
Recommendations of the Working Group on Functional Diagnostics of the Association of Cardiologists of Ukraine and the All-Ukrainian Association of Echocardiography Specialists. К.,2015. (in Ukr.).
Celermajer DS, Sorensen KE, Bull C, Robinson J, Deanfield JE. Endothelium-dependent dilatation in the systemic arteries of asymptomatic subjects relates to coronary risk factors and their interaction. J Am Coll Cardiol. 1994;24(6):1468–1474. https://www.ncbi.nlm.nih.gov/pubmed/7930277
Comin-Colet J, Lainscak M, Dickstein K, Filippatos GS, Johnson P, Lüscher TF, Mori C, Willenheimer R, Ponikowski P, Anker SD. The effect of intravenous ferric carboxymaltose on health-related quality of life in patients with chronic heart failure and iron deficiency: a subanalysis of the FAIR-HF study. Europ. Heart J. 2013;34:30–38. doi: 10.1093/eurheartj/ehr504
Divakaran V, Mehta S, Yao D, Hassan S, Simpson S, Wiegerinck E, Swinkels DW, Mann DL, Afshar-Kharghan V. Hepcidin in anemia of chronic heart failure. Am. J. Hematology. 2011;86(1):107-109. DOI: 10.1002/ajh.21902.
Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood. 2003;102:783–788.
Girelli D, Nemeth E, Swinkels D. Hepcidin in the diagnosis of iron disorders. Blood. 2016;127:2809–2813. DOI: 10.1182/blood-2015-12-639112.
Guyatt, GH, Sullivan, MJ, Thompson, PJ. The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J. 1985;132:919–23.
Jankovska E, von Haeling S, Anker S, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Europ. Heart J. 2013;34:816–826. DOI 10.1093/eurheartj/ehs224
Jankowska E, Rozentryt P, Witkowska A, Nowak J, Hartman O, Ponikowska B, Borodulin-Nadzieja L, Banasiak W, Polonski L, Filippatos G, Murray JMc, Anker S, Ponikowski P. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Europ. Heart J. 2010;31:1872–1880. doi: 10.1093/eurheartj/ehq158.
Jankowska E, Tkaczyszyn M, Suchocki T, Drozd M, von Haehling S, Doehner W, Banasiak W, Filippatos G, Anker S, Ponikowski P. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur. J. Herat Failure. 2016;18:786–795. doi: 10.1002/ejhf.473
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 3rd, 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.
Nemeth E, Rivera S, Gabayan V, Keller C, Taudorf S, Pedersen BK, Ganz T. IL-6 mediates hypoferremia of inflammation by inducing the synthesis of the iron regulatory hormone hepcidin. J. Clin. Invest. 2004;113:1271–6.
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P; ESC Scientific Document Group. July. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). European Heart Journal 2016;37(27):2129–2200. doi: 10.1093/eurheartj/ehw128. Epub 2016 May 20.
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.
Sandek A, Rauchhaus M, Anker S. The emergin role of the gut in chronic heart failure. Curr. Opin. Clin. Nutr. Metab. Care. 2008;11:632–639.
Silverberg D, Wexler D, Jaina A. The importance of anemia and its correction in the management of severe congestive heart failure. Europ. J. Heart failure. 2002;4:681–686.
Thachil J. Iron deficiency: still under-diagnosed? Br. J. Hosp. Med. 2015;76:528–532.
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). (http://www.who.int/vmnis/indicators/haemoglobin_ru.pdf)