Relationship of Iron Deficiency, Anemia and Combination of Iron Deficiency With Anemia With Severity of Manifestations of Chronic Heart Failure. Additional Analysis of the Study “Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)”
https://doi.org/10.18087/cardio.2024.11.n2786
Abstract
Aim To evaluate the role of iron deficiency (ID) identified by various criteria, anemia, and the combination of ID and anemia in determining the severity of the clinical course of chronic heart failure (CHF) in a retrospective analysis of data from 498 patients who participated in the ID-CHF-RF Russian multicenter program.
Material and methods ID was diagnosed by the following three criteria established by the European Society of Cardiology (ESC) and the Russian Society of Cardiology (RSC): 1) ferritin concentration <100 μg/l or ferritin concentration 100-299 μg/l in combination with a decreased transferrin saturation (TS) <20%; 2) ID criteria that showed a high sensitivity and specificity when compared with bone marrow morphology (BMM): TS ≤19.8% or serum iron (SI) ≤13 μmol/l; and 3) a composite index including a ferritin concentration <100 μg/l in combination with TS <20% and SI ≤13 μmol/l. The presence of anemia was defined as a hemoglobin concentration of less than 12.0 g/dl in women and less than 13.0 g/dl in men according to the criteria of the World Health Organization.
Results Concomitant anemia was detected in 40.3% of patients with CHF; in 85.1% of cases, anemia was combined with the SI concentration below normal. CHF patients with concomitant anemia were significantly older and had low levels of not only red blood cells and hemoglobin but also all parameters of iron metabolism, i.e., SI, ferritin concentration, and TS. The mean deviation of the red blood cell size, that characterizes the degree of anisocytosis, was significantly increased in patients with anemia, especially with a low SI. These patients had a higher CHF functional class, elevated levels of N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) and walked a shorter distance in the 6-minute walk test, which reflects significantly more severe manifestations of CHF with concomitant anemia, particularly in combination with a low SI. The incidence of ID was 83.1% (including 23.3% in combination with anemia) according to the ESC/RSC criteria; 74.5% (including 43.3% with anemia) according to the BMM criteria; and 51.6% (including 51.7% with anemia) according to the composite index, which seems to be stricter compared to the first two criteria. Regardless of the assessment method (by total weighted average data), in ID combined with anemia, not only the hemoglobin concentration was significantly reduced but all three analyzed parameters of iron metabolism were also significantly reduced (SI 9.0 μmol/l vs. 10.4 μmol/l; ferritin 41 μg/l vs. 59 μg/l; TS 8.5% vs. 12.9%) compared to ID without anemia, respectively. The CHF severity and the NT-proBNP concentration were also maximum for the combination of ID and anemia, in contrast to ID without anemia, regardless of the ID criterion used. A more accurate comparison of the methods for determining ID in CHF in the context of their prognostic value will be obtained by analyzing the data of a two-year follow-up of patients in this study, which will be the subject of the next article.
Conclusion This analysis suggests that the presence of concomitant ID without anemia or anemia without ID moderately affects the severity of clinical manifestations of CHF and may be rather markers than factors determining the course of the disease, and in this case, does not require special correction with iron medications. And only ID anemia (a combination of ID with anemia) in patients with CHF can be considered a condition requiring special correction (for example, with intravenous medication) in addition to optimal therapy for CHF. This conclusion does not change depending on the used criteria for ID and requires verification in new RCTs.
Supporting agencies: The ID-CHF-RF study was initiated by the Society of Experts in Heart Failure. Funding of the statistical analysis for this article was a part of the State Assignment of the Lomonosov Moscow State University. No conflicts of interest are reported.
About the Authors
V. Yu. Mareev
Medical Research and Educational Institute of the Lomonosov Moscow State University, Moscow
Doctor of Medical Sciences, Professor, Chief Researcher
Zh. D. Kobalava
Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, Moscow;
Vinogradov Municipal Clinical Hospital, Moscow
Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Head of the Department of Internal Medicine with a Course in Cardiology and Functional Diagnostics named after Academician V.S. Moiseev
Yu. V. Mareev
Robertson Center for Biostatistics, Glasgow University, Glasgow
United Kingdom
United Kingdom
PhD
Yu. L. Begrambekova
Medical Research and Educational Institute of the Lomonosov Moscow State University, Moscow
Russian Federation
Russian Federation
PhD, Leading Researcher, Department of Age-Associated Diseases
L. V. Karapetyan
Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, Moscow;
Vinogradov Municipal Clinical Hospital, Moscow
PhD, professor
S. A. Galochkin
Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, Moscow;
Vinogradov Municipal Clinical Hospital, Moscow
PhD in Medicine, Associate Professor at the Department of Internal Medicine with the Course of Cardiology and Functional Diagnostics named after Academician V.S. Moiseev
E. R. Kazakhmedov
Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, Moscow;
Vinogradov Municipal Clinical Hospital, Moscow
PhD in Medicine, Associate Professor at the Department of Internal Medicine with the Course of Cardiology and Functional Diagnostics named after Academician V.S. Moiseev
A. A. Lapshin
Moiseev Department of Internal Diseases with a Course of Cardiology and Functional Diagnostics, Medical Institute, Patrice Lumumba Peoples’ Friendship University of Russia, Moscow;
Vinogradov Municipal Clinical Hospital, Moscow
Assistant professor of department of internal medicine with courses of cardiology and functional diagnostics
A. A. Garganeeva
Research Institute of Cardiology, Tomsk Research Medical Center of the Russian Academy of Sciences, Tomsk
MD, Professor, Head of the Department of Myocardial Pathology, Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences
E. A. Kuzheleva
Research Institute of Cardiology, Tomsk Research Medical Center of the Russian Academy of Sciences, Tomsk
Candidate of Medical Sciences, Senior Researcher, Department of Myocardial Pathology
A. A. Efremushkina
Altai State Medical University, Barnaul;
Altai Territorial Cardiological Dispensary, Barnaul
Professor of the Department of Therapy and General Medical Practice
with the cource of DPO of the Altai State Medical University, Professor, Doctor of Medical Science
E. V. Kiseleva
Altai Territorial Cardiological Dispensary, Barnaul
assistant professor of the Department of Therapy and General Medical Practice with the cource of DPO
O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Director, Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences
T. B. Pecherina
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Senior researcher of the laboratory of circulatory pathology. PhD, associate professor
A. S. Galyavich
Kazan State Medical University, Kazan
Doctor of Medical Sciences, Professor, Head of the Department of Cardiology
Z. M. Galeeva
Kazan State Medical University, Kazan
Candidate of Medical Sciences, Associate Professor of the Department of Cardiology
L. V. Baleeva
Kazan State Medical University, Kazan
Candidate of Medical Sciences, Associate Professor of the Department of Cardiology
N. A. Koziolova
Vagner Perm State Medical University, Perm
MD, Professor, Head of the Department of Internal Medicine Propaedeutics No. 2
A. S. Veklich
Vagner Perm State Medical University, Perm
PhD, cardiologist
D. V. Duplyakov
Research Institute of Cardiology, Samara State Medical University, Samara;
Polyakov Samara Regional Clinical Cardiological Dispensary, Samara
MD, ProfessorHead of Department Department of Propaedeutic Therapy with a Course in Cardiology
M. N. Maksimova
Polyakov Samara Regional Clinical Cardiological Dispensary, Samara
Professor, Deputy Chief Physician for Medical Affairs
S. S. Yakushin
Pavlov Ryazan State Medical University, Ryazan;
Regional Clinical Cardiology Dispensary, Ryazan
Doctor of Medical Sciences, Professor, Head of the Department of Hospital Therapy with a Course in Medical and Social Expertise
E. A. Smirnova
Regional Clinical Cardiology Dispensary, Ryazan
Head of Cardiology Department No. 1
E. V. Sedykh
Pavlov Ryazan State Medical University, Ryazan;
Regional Clinical Cardiology Dispensary, Ryazan
postgraduate student of the Department of Internal Medicine
I. I. Shaposhnik
South Ural State Medical University, Chelyabinsk
Dr. Sci (Med.), professor, Chair of Propaedeutics of Internal Diseases Department
N. A. Makarova
South Ural State Medical University, Chelyabinsk
Dr. Sci (Med.), associate professor, professor of Propaedeutics of Internal Diseases Department
A. A. Zemlyanukhina
Chelyabinsk Municipal Clinical Hospital #1, Chelyabinsk
cardiologist
V. V. Skibitskiy
Kuban State Medical University, Krasnodar
PhD, Associate Professor, Department of Hospital Therapy
A. V. Fendrikova
Kuban State Medical University, Krasnodar
PhD, Associate Professor, Department of Hospital Therapy
A. V. Skibitskiy
Kuban State Medical University, Krasnodar
PhD, Associate Professor, Department of Hospital Therapy
N. A. Spiropulos
Clinical Hospital of Emergency Medical Care, Krasnodar
Ph.D. of Medical Sciences, Head of the Cardiology Department No. 2
E. M. Seredenina
Medical Research and Educational Institute of the Lomonosov Moscow State University, Moscow
PhD, Senior Researcher
Ya. A. Orlova
Medical Research and Educational Institute of the Lomonosov Moscow State University, Moscow
Doctor of Medical Sciences, Professor, Deputy Director of the Moscow State University Scientific and Educational Center
K. A. Eruslanova
Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University, Moscow
Head of the Laboratory of Cardiovascular Aging, Assistant Professor, Department of Aging Diseases, Faculty of Continuing Professional Education, PhD
Yu. V. Kotovskaya
Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University, Moscow
Deputy Director for Research, MD, Professor
O. N. Тkacheva
Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University, Moscow
Corresponding Member of the Russian Academy of Sciences, Doctor of Medical Sciences, Professor, Head of the Department of Diseases of Aging
M. A. Fedin
Russian Gerontological Research and Clinical Center, Pirogov Russian National Research Medical University, Moscow;
Pirogov Russian National Research Medical University, Moscow
cardiologist
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Review
For citations:
Mareev V.Yu., Kobalava Zh.D., Mareev Yu.V., Begrambekova Yu.L., Karapetyan L.V., Galochkin S.A., Kazakhmedov E.R., Lapshin A.A., Garganeeva A.A., Kuzheleva E.A., Efremushkina A.A., Kiseleva E.V., Barbarash O.L., Pecherina T.B., Galyavich A.S., Galeeva Z.M., Baleeva L.V., Koziolova N.A., Veklich A.S., Duplyakov D.V., Maksimova M.N., Yakushin S.S., Smirnova E.A., Sedykh E.V., Shaposhnik I.I., Makarova N.A., Zemlyanukhina A.A., Skibitskiy V.V., Fendrikova A.V., Skibitskiy A.V., Spiropulos N.A., Seredenina E.M., Orlova Ya.A., Eruslanova K.A., Kotovskaya Yu.V., Тkacheva O.N., Fedin M.A. Relationship of Iron Deficiency, Anemia and Combination of Iron Deficiency With Anemia With Severity of Manifestations of Chronic Heart Failure. Additional Analysis of the Study “Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (J-CHF-RF)”. Kardiologiia. 2024;64(11):62-75. (In Russ.) https://doi.org/10.18087/cardio.2024.11.n2786
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