Barandiarán Aizpurua Arantxa, Sanders-van Wijk Sandra, Brunner-La Rocca Hans-Peter, Henkens Michiel T H M, Weerts Jerremy, Spanjers Mireille H A, Knackstedt Christian, van Empel Vanessa P M
Department of Cardiology, Maastricht University Medical Centre (MUMC+), PO 5800, Maastricht, 6202AZ, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
ESC Heart Fail. 2021 Apr;8(2):1304-1313. doi: 10.1002/ehf2.13204. Epub 2021 Jan 31.
Whether and how iron deficiency (ID) impacts patients with heart failure (HF) with preserved ejection fraction (HFpEF) remain unclear. The aim of our study was to investigate the impact of ID on functional status, exercise capacity, and prognosis in HFpEF.
The study population consisted of 300 HFpEF patients. ID was defined as serum ferritin <100 μg/L or 100-300 μg/L and transferrin-saturation <20%. Baseline functional status, quality of life (HADS score and EQ 5D index), 6 min walking test, echocardiography, and outcome (all-cause mortality and combined all cause-mortality and HF hospitalization) were evaluated. ID was found in 159 (53%) patients. Patients with ID had a worse prognosis with a higher combined endpoint of all-cause mortality and HF hospitalization after 4 years of follow-up (log rank = 0.008). Pulmonary hypertension, depression, and thyroid disease were more prevalent in the ID group. Multivariable analysis showed that ID was independently associated with body mass index (P = 0.003), pulmonary hypertension (P = 0.008), and thyroid disease (P = 0.01). Although patients with ID had a lower exercise capacity compared with patients without ID (393 m [294-455] vs. 344 m [260-441], P = 0.008), there was no significant correlation after multivariable correction for age, BMI, NT-proBNP, DM, and depression.
Heart failure with preserved ejection fraction patients with ID have a worse prognosis and impaired exercise capacity compared with those without ID. However, although a trend was observed, after multivariable correction ID was no longer significantly associated with a reduced exercise capacity. This reflects that impaired exercise capacity in HFpEF is complex and seems multifactorial. Interestingly, pulmonary hypertension was an independent predictor of both ID and exercise capacity.
缺铁（ID）是否以及如何影响射血分数保留的心力衰竭（HFpEF）患者仍不清楚。我们研究的目的是调查ID对HFpEF患者功能状态、运动能力和预后的影响。
研究人群包括300例HFpEF患者。ID定义为血清铁蛋白<100μg/L或100 - 300μg/L且转铁蛋白饱和度<20%。评估了基线功能状态、生活质量（医院焦虑抑郁量表评分和EQ 5D指数）、6分钟步行试验、超声心动图以及结局（全因死亡率和全因死亡率与HF住院率的综合指标）。159例（53%）患者存在ID。ID患者预后较差，随访4年后全因死亡率和HF住院率的综合终点更高（对数秩检验=0.008）。ID组中肺动脉高压、抑郁症和甲状腺疾病更为常见。多变量分析显示，ID与体重指数独立相关（P = 0.003）、肺动脉高压（P = 0.008）和甲状腺疾病（P = 0.01）。尽管与无ID的患者相比，ID患者的运动能力较低（393米[294 - 455] vs. 344米[260 - 441]，P = 0.008），但在对年龄、体重指数、N末端脑钠肽前体、糖尿病和抑郁症进行多变量校正后，无显著相关性。
与无ID的射血分数保留的心力衰竭患者相比，有ID的患者预后更差且运动能力受损。然而，尽管观察到一种趋势，但在多变量校正后，ID与运动能力降低不再显著相关。这反映出HFpEF中运动能力受损是复杂的，似乎是多因素的。有趣的是，肺动脉高压是ID和运动能力的独立预测因素。
