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Does too little iron in your body predict acute heart failure?

Do you have an iron deficiency resulting from what foods you eat? Negative iron balance predicts survival in patients with acute heart failure, according to research presented for the first time May 17, 2014 at the Heart Failure Congress 2014 in Athens, Greece. The Congress is the main annual meeting of the Heart Failure Association of theEuropean Society of Cardiology. Iron is needed for cellular metabolism: Not too much or too little. Negative iron balance predicts acute heart failure survival, says new research.

Professor Ewa Jankowska, first author of the study, said, according to the May 17, 2014 news release, Negative iron balance predicts acute heart failure survival, "Patients with acute heart failure have a major collapse in homeostasis. Iron is a key micronutrient that is required for the maintenance of homeostasis. Iron is needed for cellular metabolism and deficiency leads to severely impaired energy metabolism and mitochondrial dysfunction."

She continued, according to the news release, "Previous studies have shown that patients at high cardiovascular risk – for example diabetics with coronary artery disease or patients with stable chronic heart failure – may develop iron deficiency which leads to recurrent hospitalizations and increased mortality."

Professor Piotr Ponikowski, last author, said, according to the news release, "We have data showing that iron may be important for clinical outcomes in chronic heart failure and correction of iron deficiency in these patients is beneficial. This is the first study of iron status in acute heart failure."

Iron deficiency has traditionally been measured using serum ferritin to track iron stores and transferrin saturation (TSAT) to assess iron utilization in the cell. These measures cannot be reliably interpreted in acute clinical settings because they are influenced by inflammation and oxidative stress.

A new, more sensitive way of measuring how much iron you have in your body

The researchers therefore proposed a new, more sensitive, measure for acute heart failure which can best characterize iron deficiency in these settings. This refers to both depleted iron stores, measured by circulating hepcidin, and unmet cellular iron needs, measured by soluble transferrin receptor.

The receptor is expressed on all cells and enables iron to enter the cell. When there is not enough iron in the cell, the receptor is overexpressed and shed into the circulation. Concomitance of low hepcidin and high soluble transferrin receptor reflects the most severe form of iron deficiency (lack of iron in the body accompanied by iron need), which the investigators called negative iron balance (NIB).

Balancing the iron in your diet

This prospective, observational study included 165 patients hospitalized for acute heart failure. The researchers assessed the prevalence of NIB and its impact on 12 month mortality.

NIB was found in 37% of patients. Just 29% had only high soluble transferrin receptor, while 9% had only low hepcidin and 25% had none of these abnormalities. Twelve month mortality was 20% for the whole group. Patients with NIB had the highest 12 month mortality (41%) compared to those with only high soluble transferrin receptor (15%), only low hepcidin (7%) and none of these abnormalities (0%) (p<0.001). During the hospital stay 3 patients died and all had NIB.

Professor Jankowska said, according to the news release, "Our study shows that deranged iron status is common in acute heart failure. Mortality in the patients with NIB was high during the 12 month follow up, whereas all of the patients with no iron abnormalities survived to one year."

NIB led to poorer survival in acute heart failure patients regardless of whether they were anemic or not

The researchers also measured the standard parameters of iron status, serum ferritin and TSAT, and found that they were less able to predict 12 month mortality than NIB. Levels of serum ferritin and TSAT were only weakly correlated with hepcidin and soluble transferrin receptor.

Professor Ponikowski said, according to the news release, "Levels of hepcidin and soluble transferrin receptor are more clinically relevant in patients with acute heart failure than traditional measures of iron status. We propose a new pathophysiological definition of iron deficiency which accurately reflects stored and utilized iron in patients with acute heart failure."

Both concluded, according to the news release, "Iron supplementation may reverse NIB and improve survival in acute heart failure patients but this needs to be tested in a randomized clinical trial. We hope to initiate such trial soon."

For practical information about heart failure aimed at patients, families and caregivers, visit the HFA's Heart Failure Matters website. For further information, you can check out this website for the current final program. Or for full details of a session, have a look at the Scientific Program and Planner website.