PMID- 21903058
OWN - NLM
STAT- MEDLINE
DCOM- 20111027
LR  - 20201216
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 58
IP  - 12
DP  - 2011 Sep 13
TI  - Disordered iron homeostasis in chronic heart failure: prevalence, predictors, and 
      relation to anemia, exercise capacity, and survival.
PG  - 1241-51
LID - 10.1016/j.jacc.2011.04.040 [doi]
AB  - OBJECTIVES: The aim of this study was to comprehensively delineate iron 
      metabolism and its implications in patients with chronic heart failure (CHF). 
      BACKGROUND: Iron deficiency is an emerging therapeutic target in CHF. METHODS: 
      Iron and clinical indexes were quantified in 157 patients with CHF. RESULTS: 
      Several observations were made. First, iron homeostasis was deranged in anemic 
      and nonanemic subjects and characterized by diminished circulating (transferrin 
      saturation) and functional (mean cell hemoglobin concentration) iron status in 
      the face of seemingly adequate stores (ferritin). Second, while iron overload and 
      elevated iron stores were rare (1%), iron deficiency (transferrin saturation 
      <20%) was evident in 43% of patients. Third, disordered iron homeostasis related 
      closely to worsening inflammation and disease severity and strongly predicted 
      lower hemoglobin levels independently of age, sex, erythrocyte sedimentation 
      rate, New York Heart Association (NYHA) functional class, and creatinine. Fourth, 
      the etiologies of anemia varied with disease severity, with an iron-deficient 
      substrate (anemia of chronic disease and/or iron-deficiency anemia) evident in 
      16%, 72%, and 100% of anemic NYHA functional class I or II, III, and IV patients, 
      respectively. Although anemia of chronic disease was more prevalent than 
      iron-deficiency anemia, both conditions coexisted in 17% of subjects. Fifth, iron 
      deficiency was associated with lower peak oxygen consumption and higher ratios of 
      ventilation to carbon dioxide production and identified those at enhanced risk 
      for death (hazard ratio: 3.38; 95% confidence interval: 1.48 to 7.72; p = 0.004) 
      independently of hemoglobin. Nonanemic iron-deficient patients had a 2-fold 
      greater risk for death than anemic iron-replete subjects. CONCLUSIONS: Disordered 
      iron homeostasis in patients with CHF relates to impaired exercise capacity and 
      survival and appears prognostically more ominous than anemia.
CI  - Copyright (c) 2011 American College of Cardiology Foundation. Published by Elsevier 
      Inc. All rights reserved.
FAU - Okonko, Darlington O
AU  - Okonko DO
AD  - Clinical Cardiology, National Heart & Lung Institute, Imperial College London, 
      London, United Kingdom.
FAU - Mandal, Amit K J
AU  - Mandal AK
FAU - Missouris, Constantinos G
AU  - Missouris CG
FAU - Poole-Wilson, Philip A
AU  - Poole-Wilson PA
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - E1UOL152H7 (Iron)
SB  - IM
CIN - J Am Coll Cardiol. 2011 Sep 13;58(12):1252-3. PMID: 21903059
MH  - Aged
MH  - Aged, 80 and over
MH  - Anemia/*metabolism
MH  - Anemia, Iron-Deficiency/metabolism/mortality
MH  - Chronic Disease
MH  - Exercise Tolerance/*physiology
MH  - Female
MH  - Heart Failure/complications/*metabolism/mortality
MH  - Homeostasis
MH  - Humans
MH  - Iron/*metabolism
MH  - Iron Metabolism Disorders/complications/epidemiology/*metabolism/mortality
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Prognosis
MH  - Prospective Studies
EDAT- 2011/09/10 06:00
MHDA- 2011/10/28 06:00
CRDT- 2011/09/10 06:00
PHST- 2010/10/18 00:00 [received]
PHST- 2011/04/14 00:00 [revised]
PHST- 2011/04/19 00:00 [accepted]
PHST- 2011/09/10 06:00 [entrez]
PHST- 2011/09/10 06:00 [pubmed]
PHST- 2011/10/28 06:00 [medline]
AID - S0735-1097(11)02248-0 [pii]
AID - 10.1016/j.jacc.2011.04.040 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2011 Sep 13;58(12):1241-51. doi: 10.1016/j.jacc.2011.04.040.