iron-deficiency – ABC CARDIOL

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Review Article

Iron Deficiency in Heart Failure with Reduced Ejection Fraction: Pathophysiology, Diagnosis and Treatment

Guilherme Augusto Reissig Pereira et al. Luís Beck-da-Silva

Abstract

Iron deficiency (ID) is an important comorbidity in heart failure with reduced ejection (HFrEF) and is highly prevalent in both anemic and non-anemic patients. In HFrEF, iron deficiency should be investigated by measurements of transferrin saturation and ferritin. There are two types of ID: absolute deficiency, with depletion of iron stores; and functional ID, where iron supply is not sufficient despite normal stores. ID is associated with worse functional class and higher risk of death in patients with HFrEF, and scientific evidence has indicated improvement of symptoms and quality of life of these patients with treatment with parenteral iron in the form of ferric carboxymaltose. Iron plays vital roles such as oxygen transportation (hemoglobin) and storage (myoblogin), and is crucial for adequate functioning of mitochondria, which are composed of iron-based proteins and the place of energy generation by oxidative metabolism at the electron transport chain. An insufficient generation and abnormal uptake of iron by skeletal and cardiac muscle cells contribute to the pathophysiology of HF. The present review aims to increase the knowledge of the pathophysiology of ID in HFrEF, and to address available tools for its diagnosis and current scientific evidence on iron replacement therapy.

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Artigo Original

Anemia, heart failure and evidence-based clinical management

Camila Alves Pereira et al. Meliza Goi Roscani Silméia Garcia Zanati Beatriz Bojikian Matsubara

Anemia is a prevalent comorbidity and marker of a poorer prognosis in patients with heart failure (HF). Its clinical relevance, as well as its pathophysiology and the clinical management of these patients are important subjects in the specialized literature. In the present review, we describe the current concepts on the pathophysiology of anemia in HF, its diagnostic criteria, and the recommendations for iron supplementation. Also, we make a critical analysis of the major studies showing evidences on the benefits of this supplementation. The four main components of anemia are addressed: chronic disease, dilutional, “renal” and malabsorption. In patients with HF, the diagnostic criteria are the same as those used in the general population: serum ferritin levels lower than 30 mcg/L in patients without kidney diseases and lower than 100 mcg/L or serum ferritin levels between 100-299 mcg/L with transferring saturation lower than 20% in patients with chronic kidney diseases. Finally, the therapeutic possibilities for anemia in this specific patient population are discussed.

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Artigo Original

Anemia in patients with advanced heart failure

Juliano Cardoso et al. Michel Ibrahim Brito Marcelo Eidi Ochiai Milena Novaes … Fabrício Berganin Tatiana Thicon Elaine C Ferreira Kelly Regina Cristina Martins dos Reis Antonio Carlos Pereira Barretto

BACKGROUND: Anemia is linked with worsening of progress in patients with heart failure (HF). However, there are few studies of anemia in patients with advanced HF. OBJECTIVE: To evaluate the characteristics of anemia in HF at an advanced stage. METHODS: The study included 99 patients, aged > 18 and LVEF < 45%, who were hospitalized for HF compensation (FC IV/NYHA). Patients with hemoglobin (Hb) levels 12 g/dl. Anemia was an independent marker of poor prognosis in the multivariate analysis (mortality of 47% vs 24.6%, p = 0.016, relative risk of 2.54). CONCLUSION: Anemia affects approximately one third of patients with advanced HF, and iron deficiency is an important etiology. Anemic patients are older their renal function was more deteriorated. The improvement in the congestion was not enough to improve the anemia in most cases. In patients with advanced HF, anemia is an independent marker of poor prognosis.

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Iron Deficiency in Heart Failure with Reduced Ejection Fraction: Pathophysiology, Diagnosis and Treatment

Abstract

Anemia, heart failure and evidence-based clinical management

Anemia in patients with advanced heart failure

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Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)

Electronic Document Format (Vancouver)

Electronic Document Format (ABNT)

Electronic Document Format (APA)

Electronic Document Format (ISO)