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Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life

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Abstract

Background

The prevalence of iron deficiency (ID) in outpatients with heart failure with preserved ejection fraction (HFpEF) and its relation to exercise capacity and quality of life (QoL) is unknown.

Methods

190 symptomatic outpatients with HFpEF (LVEF 58 ± 7%; age 71 ± 9 years; NYHA 2.4 ± 0.5; BMI 31 ± 6 kg/m2) were enrolled as part of SICA-HF in Germany, England and Slovenia. ID was defined as ferritin < 100 or 100–299 µg/L with transferrin saturation (TSAT) < 20%. Anemia was defined as Hb < 13 g/dL in men, < 12 g/dL in women. Low ferritin-ID was defined as ferritin < 100 µg/L. Patients were divided into 3 groups according to E/e′ at echocardiography: E/e′ ≤ 8; E/e′ 9–14; E/e′ ≥ 15. All patients underwent echocardiography, cardiopulmonary exercise test (CPX), 6-min walk test (6-MWT), and QoL assessment using the EQ5D questionnaire.

Results

Overall, 111 patients (58.4%) showed ID with 89 having low ferritin-ID (46.84%). 78 (41.1%) patients had isolated ID without anemia and 54 patients showed anemia (28.4%). ID was more prevalent in patients with more severe diastolic dysfunction: E/e′ ≤ 8: 44.8% vs. E/e′: 9–14: 53.2% vs. E/e′ ≥ 15: 86.5% (p = 0.0004). Patients with ID performed worse during the 6MWT (420 ± 137 vs. 344 ± 124 m; p = 0.008) and had worse exercise time in CPX (645 ± 168 vs. 538 ± 178 s, p = 0.03). Patients with low ferritin-ID had lower QoL compared to those without ID (p = 0.03).

Conclusion

ID is a frequent co-morbidity in HFpEF and is associated with reduced exercise capacity and QoL. Its prevalence increases with increasing severity of diastolic dysfunction.

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Abbreviations

ANOVA:

Analysis of variance

ATP:

Adenosine triphosphate

BMI:

Body mass index

CPX:

Cardiopulmonary exercise test

DEXA:

Dual energy X-ray absorptiometry

HB:

Hemoglobin

HF:

Heart failure

HFpEF:

Heart failure with preserved ejection fraction

HFrEF:

Heart failure with reduced ejection fraction

ID:

Iron deficiency

LAVI:

Left atrial volume index

LV:

Left ventricular

6-MWT:

6-min walk test

NYHA:

New York Heart Association

QoL:

Quality of life

SD:

Standard deviation

SICA-HF:

Studies investigating co-morbidities aggravating heart failure

TSAT:

Transferrin saturation

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Funding

The study was funded by the European Commission’s 7th Framework program (FP7/2007–2013) under grant agreement number 241558 (clinical.trial.gov).

Author information

Authors and Affiliations

  1. Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany

    Tarek Bekfani, Daniel Morris, Wolfram Doehner & Stephan von Haehling

  2. Division of Cardiology, Angiology, Pneumology and Intensive Medical Care, Department of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University, Jena, Germany

    Tarek Bekfani & P. Christian Schulze

  3. Department of Cardiology, University of Hull, Hull, UK

    Pierpaolo Pellicori & John G. Cleland

  4. Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany

    Nicole Ebner, Miroslava Valentova, Anja Sandek & Stephan von Haehling

  5. Department of Internal Medicine, Comenius University, Bratislava, Slovakia

    Miroslava Valentova

  6. Center for Stroke Research Berlin, Charité Medical School, Berlin, Germany

    Wolfram Doehner

  7. Department of Cardiology, Golnik University, Golnik, Slovenia

    Mitja Lainscak

  8. Division of Cardiology and Metabolism-Heart Failure, Cachexia and Sarcopenia, Department of Cardiology, Campus Virchow-Klinikum, Charité Medical School, Berlin, Germany

    Stefan D. Anker

  9. Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Charité Medical School Berlin, Berlin, Germany

    Stefan D. Anker

Authors
  1. Tarek Bekfani
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  2. Pierpaolo Pellicori
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  3. Daniel Morris
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  5. Miroslava Valentova
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  8. John G. Cleland
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  9. Mitja Lainscak
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  11. Stefan D. Anker
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Corresponding author

Correspondence to Tarek Bekfani.

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Conflict of interest

SvH is consulting and has received honoraria for speaking from Solartium Dietetics, Professional Dietetics, Vifor, Novartis, Respicardia, Sorin, and Pfizer. SDA is consulting, has received honoraria for speaking and/or attended advisory boards for Amgen Inc, Professional Dietetics, Psioxus Therapeutics, GTx, Helsinn, GSK, Sanofi, Regeneron, Novartis, Takeda, Servier, Chugai and Vifor. All other authors report no conflict of interest.

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Bekfani, T., Pellicori, P., Morris, D. et al. Iron deficiency in patients with heart failure with preserved ejection fraction and its association with reduced exercise capacity, muscle strength and quality of life. Clin Res Cardiol 108, 203–211 (2019). https://doi.org/10.1007/s00392-018-1344-x

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  • DOI: https://doi.org/10.1007/s00392-018-1344-x

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