Minà Chiara, Dell'Oglio Sonia, Magro Serena, Trapanese Caterina, La Franca Eluisa, Caronia Alessandra, Clemenza Francesco
Unità di Cardiologia, Dipartimento per il Trattamento e lo Studio delle Malattie Cardiotoraciche e i Trapianti Cardiotoracici, IRCCS-ISMETT, Palermo.
Cardiologia - UTIC; Ospedale S. Elia, Caltanissetta.
Recenti Prog Med. 2020 Jul-Aug;111(7):444-453. doi: 10.1701/3407.33926.
Iron deficiency in heart failure is a frequent condition and may be a prerequisite for the development of anemia but not necessarily the two conditions coexist. Iron deficiency in itself independently of the presence of anemia, determines a series of alterations of the cellular processes of our body related to the production of energy in the form of ATP, cell proliferation and DNA synthesis. The causes of iron deficiency are several and among the various, the inflammatory state present in chronic heart failure, combined with the absorption deficit seems to play a predominant role. This review aims to cover all the main aspects related to iron deficiency in patients with heart failure starting from aetiology up to the therapeutic implications. In particular, the different causes and the pathophysiological mechanisms that underlie the iron deficiency will be examined, describing what are the consequences on the alterations on the biochemical processes in terms of absorption, transport and use of iron by target cells with particular regard to muscle cells and Erythropoietic line. The meaning, the role and the importance in clinical practice of the different laboratory tests that dose the iron (Ferritin, Serum Iron, Transferrin and Transferrin saturation or TSAT) that allow to identify the presence of absolute or relative iron deficiency will also be underlined. Literature data related to the consequences of iron deficiency and to the alterations concerning its transport on the symptoms and functional capacity of patients with heart failure will be reported as well as their impact on prognosis. A second part of the paper will address the main aspects related to iron therapy. We will discuss the administration of iron per os with regard to the different drugs, to the processes of absorption and to the use of different pharmaceutical formulations with their associated side effects. The scientific evidences on parenteral formulations and in particular on the use of Fe-carboxymaltose will be reported. Finally, we will discuss the role of erythropoietin in the context of heart failure.
心力衰竭中的缺铁是一种常见情况，可能是贫血发生的先决条件，但这两种情况不一定同时存在。缺铁本身独立于贫血的存在，决定了我们身体细胞过程的一系列改变，这些改变与以三磷酸腺苷（ATP）形式产生能量、细胞增殖和DNA合成有关。缺铁的原因有多种，在各种原因中，慢性心力衰竭中存在的炎症状态与吸收不足相结合，似乎起着主要作用。本综述旨在涵盖与心力衰竭患者缺铁相关的所有主要方面，从病因到治疗意义。特别是，将研究缺铁背后的不同原因和病理生理机制，描述在铁的吸收、运输和靶细胞（特别是肌肉细胞和红细胞生成系）利用方面的生化过程改变会产生哪些后果。还将强调不同实验室检测（铁蛋白、血清铁、转铁蛋白和转铁蛋白饱和度或TSAT）在临床实践中的意义、作用和重要性，这些检测有助于识别绝对或相对缺铁的存在。还将报告与缺铁后果及其运输改变对心力衰竭患者症状和功能能力的影响相关的文献数据，以及它们对预后的影响。本文的第二部分将探讨与铁治疗相关的主要方面。我们将讨论口服铁剂的给药情况，涉及不同药物、吸收过程以及不同药物制剂的使用及其相关副作用。将报告关于胃肠外制剂，特别是铁羧麦芽糖使用的科学证据。最后，我们将讨论促红细胞生成素在心力衰竭背景下的作用。
