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What is the difference in clinical, instrumental characteristics and prognosis in patients with CHF and rLVEF in regard to the presence and nature of the iron deficiency state?
1NSC Institute of Cardiology M.D. Strazhesko, Heart failure - Kiev - Ukraine
The aim is to compare chronic heart failure (CHF) and reduced left ventricular ejection fraction (rLVEF) patients with absolute and functional iron deficiency (ID) according to the main clinical, hemodynamic, laboratory parameters and clinical outcomes.
Methods. 128 stable compensated patients (pts) with CHF (111 men, 17 women), 18-75 years old, NYHA class II-IV, LVEF<40% were examined. Beside routine clinical and laboratory examination, iron panel test, 6 min walk test (6MWT), standardized endurance leg extensor test were performed. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ). Statistical calculations were made using Spearman’s rank correlation coefficient, Pearson’s chi-squared test and Kaplan-Meyer estimator.
Results. ID was observed in 78 pts. All pts were divided into 3 groups: group #1 – functional ID (n=27), #2 – absolute ID (n=51), #3 – without ID (n=50). Patients with both ID types were in higher (NYHA III-IV) functional class (85% pts from group #1 vs. 71% from group #2 vs. 48% #3, p=0,02; 0,001), had a poorer quality of life (MLHFQ score 56 in group #1 vs. 53 in #2 vs. 45 in #3, p=0,01; 0,03) and worse clinical and laboratory indices than patients without ID (Hb 145 g/l in group #1 vs. 136 g/l in group #2 vs. 151 g/l in #3, p<0,001. NTproBNP 637 ng/dl in #1 vs. 356 ng/dl in #2 vs. 247 in #3, p=0,007; <0,001. IL6 5 pg/ml in group #1 vs. 2,4 pg/ml in #2 vs. 1,7 pg/ml in #3, p=0,03; <0,001. Citrulline 135 mmol/L #1 vs. 107 mmol/L #2 vs. 90 mmol/L #3, p= 0,04; <0,01). Regardless of the difference in the functional and absolute ID formation mechanisms, no significant distinctions in the clinical and functional parameters, quality of life, as well as the intracardiac hemodynamics parameters were found (LVEF 26% in group #1 vs. 27% in #2, p=0,9. Leg extensor endurance test 23 times in #1 vs. 22 times in #2, p=0,6. 6MWT 265 m in #1 vs. 346 m in #2, p=0,06. MLHFQ score 56 in #1 vs. 53 in #2, p=0,57). Contrary to expectations, elevated levels of hepcidin were not detected in patients with functional ID group compared to the absolute ID group (62 ng/ml in group #1 vs. 70 ng/ml in #2, p =0,22). The reliable difference in survival (p=0,031) / hospitalization (p=0,04) rate between patients without ID and both groups with ID allows us to recommend the ID screening in all pts with CHF and rLVEF.
Conclusions. ID was found in 61% of patients. 27 pts (21%) had functional ID, 51 pts (39.6%) had absolute ID. There were no differences between groups with absolute and functional ID in regard to age, functional class, LVEF, aneamic patients percentage, 6MWT distance, thigh quadriceps endurance, quality of life, physical activity index, NTproBNP, citrulline and hepcidin levels. Compared to patients with absolute ID, patients with functional ID had higher levels of hemoglobin, MCV, MCH, interleukin 6. Presence of both ID types was associated with worse survival rate and more frequent hospitalization.
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