Author + information
- Ewa Anita Jankowska,
- Tomasz Suchocki,
- Katarzyna Wojtas,
- Grzegorz Mazur,
- Aleksandra Butrym,
- Ilona Rybinska,
- Piotr Rozentryt,
- Peter van der Meer,
- Josep Comin-Colet,
- IJsbrand Klip,
- Adriaan Voors,
- Waldemar Banasiak and
- Piotr Ponikowski
Iron deficiency (ID) is frequent in heart failure (HF), linked with exercise intolerance and poor prognosis. Its correction with intravenous iron improves clinical status. Accurate diagnosis of ID is mandatory, but remains uncertain, as the definition of ID based on circulating iron biomarkers may be unreliable.
To assess the prevalence of ID in bone marrow in patients with ischemic systolic HF, to assign the iron biomarker with the best accuracy for the diagnosis of ID in bone marrow, to establish the prevalence of ID using this biomarker and its impact on survival in patients with systolic HF.
Design, Setting and Participants
A case control study with iron staining in bone marrow in 30 patients with ischemic HF, and 10 healthy controls, and an observational study at 3 tertiary cardiology centers of 791patients with systolic HF. Main Outcome Measures: Bone marrow specimens were stained for iron, and ID was diagnosed for 0-1 grades according to Gale scale. Serum ferritin, iron, transferrin saturation (Tsat), soluble transferrin receptor (sTfR) were assessed as circulating iron biomarkers.
ID in bone marrow was found in 25 (83%) of patients with ischemic HF, and none of controls (p<0.001). Serum sTfR had the best accuracy in predicting ID in bone marrow (area under curve: 0.920±0.063, for cut-off of ≥1.25 mg/L – sensitivity: 67%, specificity: 100%). Serum sTfR ≥1.25 mg/L was found in 47% of all patients with systolic HF, in 56% and 46% of anemics and non-anemics, respectively (p<0.05). The reclassification methods revealed that serum sTfR significantly added the prognostic value to the baseline prognostic model, and its additive prognostic value was greater than that of plasma NT-proBNP. Based on the internal derivation and validation procedures, serum sTfR ≥1.41±1.13 mg/L was established as the cut-off with the best accuracy in predicting death at 3-year follow-up.
High serum sTfR accurately reflects depleted iron stores in bone marrow in patients with systolic HF, and allows to identify those of high mortality.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: New Paradigms in Prognostic Role of Biomarkers in Heart Failure
Abstract Category: 15. Heart Failure: Clinical
Presentation Number: 1265-301
- 2013 American College of Cardiology Foundation