Congenital and Structural Cardiology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Eur Heart J. 2011 Nov;32(22):2790-9. doi: 10.1093/eurheartj/ehr130. Epub 2011 May 23.
Iron deficiency is common in patients with Eisenmenger syndrome (ES). This study aimed at evaluating (i) whether iron deficiency is related with adverse outcome, (ii) the determinants of iron deficiency, and (iii) the relation between iron reserves and haemoglobin level in a contemporary cohort of ES patients.
All ES patients, older than 18 years, selected from the Belgian Eisenmenger registry, were prospectively followed using a web-based registry. Univariate Cox-regression analysis was performed to evaluate the relation with outcome, defined as all-cause mortality, transplantation, and hospitalisation due to cardiopulmonary causes. Bivariate analysis was performed where applicable. A total of 68 patients with a complete dataset (mean age 36.9 ± 14.2 years; 30.9% male) were included. During a median follow-up time of 3.1 years, 21 patients (30.9%) reached the predefined endpoint. New York Heart Association (NYHA) class ≥ III (HR 4.76; 95% CI 1.84-12.30; P = 0.001), iron deficiency (HR 5.29; 95% CI 2.04-13.76; P = 0.001), mean corpuscular volume (MCV) (HR 0.94; 95% CI 0.90-0.99; P = 0.021), and mean corpuscular haemoglobin (MCH) (HR 0.87; 95% CI 0.76-0.98; P = 0.027) were related with adverse outcome. The use of oral anticoagulation and frequent phlebotomies were independently related with iron deficiency (P = 0.005 and P = 0.008). In iron-deplete patients, MCV (R = -0.408; P= 0.014) and MCH (R = -0.437; P = 0.026) were inversely related with haematocrit. In patients with low oxygen saturation, iron reserves were related with haemoglobin levels (R = 0.587; P = 0.001).
Iron deficiency was associated with a higher risk of adverse outcome. Moreover, the use of oral anticoagulation OAC and frequent phlebotomies were related to iron deficiency. Patients under anticoagulation should be monitored rigorously for iron deficiency. However, in patients with low oxygen saturations, careful iron substitution to avoid too high haemoglobin levels is suggested.
铁缺乏症在艾森曼格综合征（Eisenmenger syndrome，ES）患者中很常见。本研究旨在评估：（i）铁缺乏是否与不良结局相关；（ii）铁缺乏的决定因素；以及（iii）在 ES 患者的当代队列中，铁储备与血红蛋白水平之间的关系。
所有年龄大于 18 岁的 ES 患者均来自比利时 Eisenmenger 注册中心，前瞻性地通过基于网络的注册系统进行随访。使用单变量 Cox 回归分析评估与结局的关系，结局定义为全因死亡率、移植和因心肺原因住院。在适用的情况下，进行了双变量分析。共纳入 68 例具有完整数据集的患者（平均年龄 36.9±14.2 岁，30.9%为男性）。在中位随访时间为 3.1 年期间，21 例患者（30.9%）达到了预定的终点。纽约心脏病协会（New York Heart Association，NYHA）心功能分级≥III 级（HR 4.76，95%CI 1.84-12.30；P=0.001）、铁缺乏症（HR 5.29，95%CI 2.04-13.76；P=0.001）、平均红细胞体积（mean corpuscular volume，MCV）（HR 0.94，95%CI 0.90-0.99；P=0.021）和平均红细胞血红蛋白量（mean corpuscular haemoglobin，MCH）（HR 0.87，95%CI 0.76-0.98；P=0.027）与不良结局相关。口服抗凝剂的使用和频繁放血与铁缺乏症独立相关（P=0.005 和 P=0.008）。在铁耗竭的患者中，MCV（R=-0.408，P=0.014）和 MCH（R=-0.437，P=0.026）与红细胞压积呈负相关。在低氧饱和度的患者中，铁储备与血红蛋白水平相关（R=0.587，P=0.001）。
铁缺乏与不良结局的风险增加相关。此外，口服抗凝剂的使用和频繁放血与铁缺乏症相关。接受抗凝治疗的患者应严密监测铁缺乏症。然而，在低氧饱和度的患者中，建议谨慎补铁以避免血红蛋白水平过高。
