Department of Heart Diseases, Wroclaw Medical University, Centre for Heart Diseases, Military Hospital, ul. Weigla 5, Wroclaw, Poland.
Eur Heart J. 2010 Aug;31(15):1872-80. doi: 10.1093/eurheartj/ehq158. Epub 2010 Jun 21.
Beyond erythropoiesis, iron is involved in numerous biological processes crucial for maintenance of homeostasis. Patients with chronic heart failure (CHF) are prone to develop iron deficiency (ID), and iron supplementation improves their functional status and quality of life. We sought to examine the relationship between ID and survival in patients with systolic CHF.
In a prospective observational study, we evaluated 546 patients with stable systolic CHF [age: 55 +/- 11 (mean +/- standard deviation) years, males: 88%, left ventricular ejection fraction: 26 +/- 7%, New York Heart Association (NYHA) class (I/II/III/IV): 57/221/226/42]. Iron deficiency was defined as: ferritin <100 microg/L, or 100-300 microg/L with transferrin saturation <20%. The prevalence of ID was 37 +/- 4% [+/-95% confidence intervals (CI)] in the entire CHF population (32 +/- 4 vs. 57 +/- 10%-in subjects without vs. with anaemia defined as haemoglobin level <12 g/dL in women and <13 g/dL in men, P < 0.001). In a multiple logistic model, ID was more prevalent in women, those in the advanced NYHA class, with higher plasma N-terminal pro-type B natriuretic peptide and higher serum high-sensitivity C-reactive protein (all P < 0.05). At the end of follow-up (mean duration: 731 +/- 350 days), there were 153 (28%) deaths and 30 (6%) heart transplantations (HTX). In multivariable models, ID (but not anaemia) was related to an increased risk of death or HTX (adjusted hazard ratio 1.58, 95% CI 1.14-2.17, P < 0.01).
In patients with systolic CHF, ID is common and constitutes a strong, independent predictor of unfavourable outcome. Iron supplementation may be considered as a therapeutic approach in these patients to improve prognosis.
除了红细胞生成作用外，铁还参与了许多对维持体内平衡至关重要的生物过程。慢性心力衰竭（CHF）患者容易发生铁缺乏（ID），铁补充可改善其功能状态和生活质量。我们旨在研究 ID 与收缩性 CHF 患者生存之间的关系。
在一项前瞻性观察研究中，我们评估了 546 例稳定收缩性 CHF 患者[年龄：55 +/- 11（均值 +/- 标准差）岁，男性：88%，左心室射血分数：26 +/- 7%，纽约心脏协会（NYHA）分级（I/II/III/IV）：57/221/226/42]。铁缺乏定义为：铁蛋白 <100μg/L，或 100-300μg/L 时转铁蛋白饱和度 <20%。整个 CHF 患者人群中 ID 的患病率为 37 +/- 4%[+/-95%置信区间（CI）]（32 +/- 4%比无贫血者[定义为女性血红蛋白水平 <12g/dL 和男性血红蛋白水平 <13g/dL]高 57 +/- 10%，P < 0.001）。在多变量逻辑模型中，ID 在女性、NYHA 晚期患者中更为常见，其血浆 N 末端前 B 型利钠肽和血清高敏 C 反应蛋白较高（均 P < 0.05）。在随访结束时（平均随访时间：731 +/- 350 天），有 153 例（28%）死亡和 30 例（6%）心脏移植（HTX）。在多变量模型中，ID（而非贫血）与死亡或 HTX 的风险增加相关（校正后的危险比 1.58，95%CI 1.14-2.17，P < 0.01）。
在收缩性 CHF 患者中，ID 很常见，是不良结局的强烈独立预测因素。铁补充可能被视为改善这些患者预后的一种治疗方法。
