Department of Cardiorespiratory Medicine, Centre for Clinical Sciences, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.
Department of Cardiology, Hull University Teaching Hospital Trust, Castle Hill Hospital, Kingston-Upon-Hull, UK.
Expert Rev Cardiovasc Ther. 2022 Aug;20(8):667-681. doi: 10.1080/14779072.2022.2100349. Epub 2022 Jul 13.
Iron deficiency (ID) is common in patients with chronic heart failure (CHF) and is associated with worse symptoms and prognosis regardless of whether anemia is also present. However, randomized controlled trials (RCT) of intravenous (IV) iron in patients with CHF have produced inconsistent results. This review considers the past, present, and future of defining and treating ID in patients with CHF.
The current guideline definition of ID is a serum ferritin <100 µg/L or serum ferritin 100-299 µg/L transferrin saturation (TSAT) <20% derived from trials of IV iron in patients with end-stage renal failure. Ferritin synthesis and secretion is promoted by inflammatory cytokines which are raised in patients with CHF; thus, using ferritin to define iron deficiency in patients with CHF may be flawed. Observational data suggest that the current definition of iron deficiency in CHF does not identify a high-risk population.
Alternative indicators of ID such as low serum iron concentrations or TSAT may better identify patients with ID who are at greater risk of adverse outcome and thus, possibly, more likely to benefit from IV iron.
铁缺乏症（ID）在慢性心力衰竭（CHF）患者中很常见，无论是否存在贫血，其症状和预后都更差。然而，静脉注射（IV）铁治疗 CHF 患者的随机对照试验（RCT）得出的结果并不一致。本综述考虑了过去、现在和未来定义和治疗 CHF 患者 ID 的方法。
目前指南中 ID 的定义是血清铁蛋白<100μg/L 或血清铁蛋白 100-299μg/L 转铁蛋白饱和度（TSAT）<20%，该定义来源于终末期肾衰竭患者 IV 铁治疗的试验。铁蛋白的合成和分泌受炎症细胞因子的促进，而心力衰竭患者的炎症细胞因子水平升高；因此，使用铁蛋白来定义心力衰竭患者的缺铁可能存在缺陷。观察性数据表明，心力衰竭患者目前的缺铁定义并不能确定高危人群。
其他 ID 指标，如血清铁浓度或 TSAT 较低，可能更能识别出存在缺铁且更易发生不良预后的患者，因此，这些患者可能更有可能从 IV 铁治疗中获益。
