Miñana Gema, Santas Enrique, de la Espriella Rafael, Núñez Eduardo, Lorenzo Miguel, Núñez Gonzalo, Valero Ernesto, Bodí Vicent, Chorro Francisco J, Sanchis Juan, Cohen-Solal Alain, Bayés-Genís Antoni, Núñez Julio
Cardiology Department, Hospital Clínico Universitario, Universitat de Valencia, INCLIVA, Avda. Blasco Ibáñez 17, 46010 Valencia, Spain.
CIBER Cardiovascular, Madrid, Spain.
Eur Heart J Acute Cardiovasc Care. 2021 May 25;10(4):406-414. doi: 10.1093/ehjacc/zuaa028.
Iron deficiency (ID) is a frequent finding in patients with chronic and acute heart failure (AHF) along the full spectrum of left ventricular ejection fraction (LVEF). Iron deficiency has been related to ventricular systolic dysfunction, but its role in right ventricular function has not been evaluated. We sought to evaluate whether ID identifies patients with greater right ventricular dysfunction in the setting of AHF.
We prospectively included 903 patients admitted with AHF. Right systolic function was evaluated by tricuspid annular plane systolic excursion (TAPSE) and the ratio TAPSE/pulmonary artery systolic pressure (TAPSE/PASP). Iron deficiency was defined, according to European Society of Cardiology criteria, as serum ferritin <100 mg/dL (absolute ID) or ferritin 100-299 mg/dL and transferrin saturation (TSAT) <20% (functional ID). The relationships among the exposures with right ventricular systolic function were evaluated by multivariate linear regression analyses. The mean age of the sample was 74.3 ± 10.6 years, 441 (48.8%) were female, 471 (52.2%) exhibited heart failure with preserved ejection fraction, and 677 (75.0%) showed ID. The mean LVEF, TAPSE, and TAPSE/PASP were 49 ± 15%, 18.6 ± 3.9 mm, and 0.45 ± 0.18, respectively. The median (interquartile range) amino-terminal pro-brain natriuretic peptide was 4015 (1807-8775) pg/mL. In a multivariable setting, lower TSAT and ferritin were independently associated with lower TAPSE (P < 0.05 for both comparisons). Transferrin saturation (P = 0.017), and not ferritin (P = 0.633), was independently associated with TAPSE/PASP.
In AHF, proxies of ID were associated with right ventricular dysfunction. Further studies should confirm these findings and evaluate the pathophysiological facts behind this association.
缺铁(ID)在整个左心室射血分数(LVEF)范围内的慢性和急性心力衰竭(AHF)患者中很常见。缺铁与心室收缩功能障碍有关,但其在右心室功能中的作用尚未得到评估。我们试图评估在AHF情况下,ID是否能识别出右心室功能障碍更严重的患者。
我们前瞻性纳入了903例因AHF入院的患者。通过三尖瓣环平面收缩期位移(TAPSE)和TAPSE/肺动脉收缩压比值(TAPSE/PASP)评估右心室收缩功能。根据欧洲心脏病学会标准,缺铁定义为血清铁蛋白<100mg/dL(绝对缺铁)或铁蛋白100 - 299mg/dL且转铁蛋白饱和度(TSAT)<20%(功能性缺铁)。通过多变量线性回归分析评估暴露因素与右心室收缩功能之间的关系。样本的平均年龄为74.3±10.6岁,441例(48.8%)为女性,471例(52.2%)表现为射血分数保留的心力衰竭,677例(75.0%)存在缺铁。平均LVEF、TAPSE和TAPSE/PASP分别为49±15%、18.6±3.9mm和0.45±0.18。氨基末端脑钠肽前体的中位数(四分位间距)为4015(1807 - 8775)pg/mL。在多变量分析中,较低的TSAT和铁蛋白与较低的TAPSE独立相关(两项比较P均<0.05)。与TAPSE/PASP独立相关的是转铁蛋白饱和度(P = 0.017),而非铁蛋白(P = 0.633)。
在AHF中,缺铁指标与右心室功能障碍有关。进一步的研究应证实这些发现,并评估这种关联背后的病理生理机制。