Clinical and instrumental characteristics of patients with chronic heart failure and reduced left ventricular ejection fraction without anemia, depending on the presence of iron deficiency

Abstract

The aim – to compare patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (LVEF) without anemia depending on the presence of iron deficiency (ID) according to the main clinical, hemodynamic, laboratory parameters and prognosis indicators. Material and methods. In January – February, 2018, 95 stable patients with CHF (83 of men and 12 of women), 18–75 years old, NYHA class II–IV, with left ventricular ejection fraction < 40 % were screened. Patients were included during clinical compensation phase. Quality of life was assessed by the Minnesota living with heart failure questionnaire (MLHFQ), physical activity was estimated by the Duke University index, functional status – by assessing the 6-minute walking test and a standardized lower limb extension test.Results. ID was found in 51 out of 95 patients without anemia. Patients with ID without anemia were reliably in higher functional class, had a lower body mass index, lower systolic blood pressure, glomerular filtration rate, worse 6-minute walking test and thigh quadriceps endurance and a lower quality of life by MLHFQ. They also had lower hemoglobin, MCV, MCH, hepcidin levels and higher NT-proBNP, interleukin 6, and citrulline levels. The presence of ID, even without concomitant anemia, increased both risk of death from any cause and the combined critical event risk (death or hospitalization) during 12 and 24 months.Conclusions. Among patients with CHF and reduced LVEF without anemia, ID was observed in 54 % of patients. Patients with ID were characterized by a greater proportion of patients in NYHA class III–IV and renal dysfunction, poorer functional capacity (6-minute walking test, thigh quadriceps endurance), poorer quality of life, lower body mass index, lower systolic blood pressure and lower hemoglobin and hepcidin levels along with higher circulating interleukin 6, citrulline and NT-proBNP levels. ID without concomitant anemia was associated with worse survival and more frequent hospitalizations.