Iron deficiency and red cell indices in patients with heart failure.
AIMS
To investigate the prevalence of iron deficiency (ID) in heart failure (HF) patients with normal vs. abnormal red cell indices (RCI), the associations between iron parameters and RCI, and prognostic consequences of ID independently of RCI.


METHODS AND RESULTS
We analysed clinical data of 1821 patients with HF [mean age 66 ± 13 years; 71% men; New York Heart Association class I/II/III/IV (11%/39%/44%/6%); left ventricular ejection fraction >45%: 19%]. Iron deficiency (ferritin <100 µg/L or ferritin 100-299 µg/L with transferrin saturation <20%) was common irrespective of the presence of anaemia (haemoglobin <12 g/dL in women and <13 g/dL in men) or low RCI, from 75% in anaemic subjects with low mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and MCH concentration (MCHC), to 36% in non-anaemic subjects with MCV, MCH, and MCHC above the lower limit of normal. After adjustment for clinical variables, iron parameters remained independently associated with haemoglobin, MCV, MCH, MCHC, mean reticulocyte haemoglobin content (CHR), and red cell distribution width (RDW). In multivariable Cox proportional hazard regression models there was a trend towards higher mortality in patients with vs. without ID when adjusted for relevant HF prognosticators and MCH or MCHC (but not haemoglobin, CHR or RDW).


CONCLUSIONS
Patients with HF should be routinely screened for ID irrespective of the presence of anaemia or abnormal RCI. The detrimental impact of ID on long-term survival in HF is partially independent of RCI.
['Tkaczyszyn|Michał|M|', 'Comín-Colet|Josep|J|', 'Voors|Adriaan A|AA|', 'van Veldhuisen|Dirk J|DJ|', 'Enjuanes|Cristina|C|', 'Moliner-Borja|Pedro|P|', 'Rozentryt|Piotr|P|', 'Poloński|Lech|L|', 'Banasiak|Waldemar|W|', 'Ponikowski|Piotr|P|', 'van der Meer|Peter|P|', 'Jankowska|Ewa A|EA|']
D000368:Aged D018798:Anemia, Iron-Deficiency D004909:Erythrocyte Indices D005260:Female D006333:Heart Failure D006454:Hemoglobins D006801:Humans D007501:Iron D008297:Male D008875:Middle Aged D009426:Netherlands D011044:Poland D015995:Prevalence D011379:Prognosis D013030:Spain D016277:Ventricular Function, Left
Iron deficiency Red cell indices Heart failure Anaemia Complete blood count