PMID- 30853296
OWN - NLM
STAT- MEDLINE
DCOM- 20200212
LR  - 20200212
IS  - 1874-1754 (Electronic)
IS  - 0167-5273 (Linking)
VI  - 286
DP  - 2019 Jul 1
TI  - Relative hypochromia and mortality in acute heart failure.
PG  - 104-110
LID - S0167-5273(18)35414-7 [pii]
LID - 10.1016/j.ijcard.2019.02.060 [doi]
AB  - BACKGROUND: Relative hypochromia of erythrocytes defined as a reduced mean 
      corpuscular hemoglobin concentration (MCHC) is a surrogate of iron deficiency. We 
      aimed to evaluate the prevalence and prognostic impact of relative hypochromia in 
      acute heart failure (AHF). METHODS: We prospectively characterized 1574 patients 
      presenting with an adjudicated diagnosis of AHF to the emergency department. 
      Relative hypochromia was defined as a MCHC </=330 g/l and determined at 
      presentation. The presence of AHF was adjudicated by two independent 
      cardiologists. All-cause mortality and AHF-rehospitalization were the primary 
      prognostic end-points. RESULTS: Overall, 455 (29%) AHF patients had relative 
      hypochromia. Patients with relative hypochromia had higher hemodynamic cardiac 
      stress as quantified by NT-proBNP concentrations (p < 0.001), more extensive 
      cardiomyocyte injury as quantified by high-sensitive cardiac troponin T (hs-cTnT) 
      concentrations (p < 0.001), and lower estimated glomerular filtration rate (eGFR; 
      p < 0.001) as compared to AHF patients without hypochromia. Cumulative incidences 
      for all-cause mortality and AHF-rehospitalization at 720-days were 50% and 55% in 
      patients with relative hypochromia as compared to 33% and 39% in patients without 
      hypochromia, respectively (both p < 0.0001). The association between relative 
      hypochromia and increased mortality (HR 1.7, 95% CI 1.4-2-0) persisted after 
      adjusting for anemia (HR 1.5, 95% CI 1.3-1.8), and after adjusting for 
      hemodynamic cardiac stress (HR 1.46, 95% CI 1.21-1.76) and eGFR (HR 1.5, 95% CI 
      1.3-1.8, p < 0.001). CONCLUSIONS: Relative hypochromia is common and a strong and 
      independent predictor of increased mortality in AHF. Given the direct link to 
      diagnostic (endoscopy) and therapeutic interventions to treat functional iron 
      deficiency, relative hypochromia deserves increased attention as an inexpensive 
      and universally available biomarker.
CI  - Copyright (c) 2019 Elsevier B.V. All rights reserved.
FAU - Kleber, Martina
AU  - Kleber M
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Hematology, University Hospital Basel, University of Basel, Switzerland; 
      Department of Internal Medicine, University Hospital Basel, University of Basel, 
      Switzerland.
FAU - Kozhuharov, Nikola
AU  - Kozhuharov N
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Sabti, Zaid
AU  - Sabti Z
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Glatz, Bettina
AU  - Glatz B
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Isenreich, Rahel
AU  - Isenreich R
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Wussler, Desiree
AU  - Wussler D
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
FAU - Nowak, Albina
AU  - Nowak A
AD  - Department of Endocrinology and Clinical Nutrition, University Hospital Zurich, 
      Switzerland.
FAU - Twerenbold, Raphael
AU  - Twerenbold R
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Badertscher, Patrick
AU  - Badertscher P
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Puelacher, Christian
AU  - Puelacher C
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
FAU - du Fay de Lavallaz, Jeanne
AU  - du Fay de Lavallaz J
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Nestelberger, Thomas
AU  - Nestelberger T
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland.
FAU - Boeddinghaus, Jasper
AU  - Boeddinghaus J
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
FAU - Wildi, Karin
AU  - Wildi K
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Critical Care 
      Research Group, The Prince Charles Hospital and the University of Queensland, 
      Brisbane, Australia.
FAU - Flores, Dayana
AU  - Flores D
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
FAU - Walter, Joan
AU  - Walter J
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
FAU - Rentsch, Katharina
AU  - Rentsch K
AD  - Department of Laboratory Medicine, University Hospital Basel, Switzerland.
FAU - von Eckardstein, Arnold
AU  - von Eckardstein A
AD  - Department of Laboratory Medicine, University Hospital Zurich, Switzerland.
FAU - Goudev, Assen
AU  - Goudev A
AD  - University Hospital Sofia, Bulgaria.
FAU - Breidthardt, Tobias
AU  - Breidthardt T
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland; Department of 
      Internal Medicine, University Hospital Basel, University of Basel, Switzerland.
FAU - Mueller, Christian
AU  - Mueller C
AD  - Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), 
      University Hospital Basel, University of Basel, Switzerland. Electronic address: 
      Christian.Mueller@usb.ch.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20190227
PL  - Netherlands
TA  - Int J Cardiol
JT  - International journal of cardiology
JID - 8200291
RN  - 0 (Biomarkers)
RN  - E1UOL152H7 (Iron)
SB  - IM
CIN - Int J Cardiol. 2019 Jul 1;286:111-112. PMID: 30910282
MH  - Acute Disease
MH  - Aged
MH  - Aged, 80 and over
MH  - Anemia, Hypochromic/blood/epidemiology/*etiology
MH  - Biomarkers/blood
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/complications/*diagnosis/epidemiology
MH  - Humans
MH  - Incidence
MH  - Iron/*blood
MH  - Male
MH  - Prognosis
MH  - Prospective Studies
MH  - Risk Factors
MH  - Survival Rate/trends
MH  - Switzerland/epidemiology
OTO - NOTNLM
OT  - Acute heart failure
OT  - Mortality
OT  - Relative hypochromia
EDAT- 2019/03/12 06:00
MHDA- 2020/02/13 06:00
CRDT- 2019/03/12 06:00
PHST- 2018/09/04 00:00 [received]
PHST- 2019/02/07 00:00 [revised]
PHST- 2019/02/25 00:00 [accepted]
PHST- 2019/03/12 06:00 [pubmed]
PHST- 2020/02/13 06:00 [medline]
PHST- 2019/03/12 06:00 [entrez]
AID - S0167-5273(18)35414-7 [pii]
AID - 10.1016/j.ijcard.2019.02.060 [doi]
PST - ppublish
SO  - Int J Cardiol. 2019 Jul 1;286:104-110. doi: 10.1016/j.ijcard.2019.02.060. Epub 
      2019 Feb 27.