Iron Deficiency Predictors in Patients with Chronic Heart Failure and Reduced Left Ventricular Ejection Fraction

Abstract

The objective: to study the iron deficiency (ID) predictors in patients with chronic heart failure (CHF) and reduced left ventricular ejection fraction (rLVEF).Materials and methods. In a period from January 13, 2016 till February 28, 2018, on a basis of the Heart Failure Department of National Scientific Center «M.D. Strazhesko Institute of Cardiology, MAS of Ukraine» 134 stable patients with CHF (113 (84.3%) of men and 21 (15,7%) of women), 18–75 years old, NYHA class II-IV, with left ventricular ejection fraction <40% were screened. Patients were included in a 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 (6MWT) and a standardized lower limb extension test.Results. ID was found in 83 (62%) of 134 patients with CHF and rLVEF. ID predictors are found to be the presence of anemia, III–IV NYHA functional class and the worse quality of life by the Minnesota questionnaire. There is a lower risk of developing ID in patients with NYHA class II and with greater thigh quadriceps endurance. Probability of ID decreases with higher values of hemoglobin, MCV, MCH, GFR. At the same time, higher levels of citrulline and NTproBNP are reliably associated with increased risk of ID occurrence. According to the results of multivariable regression model, independent ID predictors are decreased erythrocyte’s MCV and elevated NTproBNP level.Conclusions. Among patients with CHF and reduced LV EF, iron deficiency is found in 62% of cases and is dependent on concomitant anemia. Risk of ID is higher in patients with NYHA class III-IV, in patients with poorer quality of life, with elevated citrulline and NTproBNP levels. Hemoglobin, MCV, MCH, GFR and better thigh quadriceps endurance are directly associated with the presence of ID. Independent predictors of ID are MCV and NTproBNP levels.