Rangel Inês, Gonçalves Alexandra, de Sousa Carla, Leite Sérgio, Campelo Manuel, Martins Elisabete, Amorim Sandra, Moura Brenda, Silva Cardoso José, Maciel Maria Júlia
Cardiology Department, Centro Hospitalar de S. João, Porto, Portugal.
Cardiology. 2014;128(4):320-6. doi: 10.1159/000358377. Epub 2014 Jun 7.
To assess the prognostic significance of iron deficiency (ID) in a chronic heart failure (CHF) outpatient population.
We prospectively evaluated 127 patients with stable CHF and left ventricular ejection fraction ≤45%. Clinical and analytical data as well as information regarding the occurrence of the composite endpoint of overall mortality and nonfatal cardiovascular events were assessed. Among the 127 patients enrolled [81% men, median age: 62 years (25th-75th percentile: 53-68)], 46 (36%) patients had ID. Women, patients with higher plasma brain natriuretic peptide levels (>400 pg/ml) and with right ventricular systolic dysfunction presented ID more frequently (p < 0.05 for all). At 225 ± 139 days of follow-up, the composite endpoint occurred in 15 (12%) patients. It was more frequent in ID (24 vs. 5%, p = 0.001) and anemic patients (25 vs. 8%, p = 0.014). In a Cox regression analysis, ID was associated with a higher likelihood of composite endpoint occurrence (HR 5.00, 95% CI 1.59-15.78, p = 0.006). In a multivariable analysis adjusted for clinical variables, including the presence of anemia, ID remained a significant predictor of the composite endpoint (HR 5.38, 95% CI 1.54-18.87, p = 0.009).
In a CHF outpatient population, ID carried a higher risk of unfavorable outcome, irrespectively of the presence of anemia.
评估缺铁（ID）在慢性心力衰竭（CHF）门诊患者中的预后意义。
我们前瞻性评估了127例稳定型CHF且左心室射血分数≤45%的患者。评估了临床和分析数据以及关于总体死亡率和非致命性心血管事件复合终点发生情况的信息。在纳入的127例患者中[81%为男性，中位年龄：62岁（第25 - 75百分位数：53 - 68岁）]，46例（36%）患者存在ID。女性、血浆脑钠肽水平较高（>400 pg/ml）以及右心室收缩功能障碍的患者ID更为常见（所有p < 0.05）。在225±139天的随访中，15例（12%）患者出现复合终点。在ID患者（24%对5%，p = 0.001）和贫血患者（25%对8%，p = 0.014）中更常见。在Cox回归分析中，ID与复合终点发生的可能性较高相关（风险比5.00，95%置信区间1.59 - 15.78，p = 0.006）。在针对包括贫血在内的临床变量进行调整的多变量分析中，ID仍然是复合终点的显著预测因素（风险比5.38，95%置信区间1.54 - 18.87，p = 0.009）。
在CHF门诊患者中，无论是否存在贫血，ID都具有更高的不良结局风险。
