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Defining Iron deficiency in acute heart failure: Preliminary results
Session:
Posters 5 - Écran 5 - Insuficiência Cardíaca
Speaker:
Bruno M. Rocha
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.3 Acute Heart Failure – Diagnostic Methods
Session Type:
Posters
FP Number:
---
Authors:
Bruno M. Rocha; Gonçalo Lopes Da Cunha; Joana A. Duarte; Rita Gomes; Inês Araújo; Cândida Fonseca
Abstract
<p><strong>Background: </strong>Iron Deficiency (ID) is defined in Heart Failure (HF) as absolute (ferritin <100µg/L) or relative [ferritin 100-300µg/L and transferrin saturation (TSAT) <20%]. In symptomatic chronic HF patients with ID and reduced left ventricular ejection fraction (LVEF), intravenous (IV) iron improves symptoms and may reduce hospitalizations. However, these results should not be extrapolated to acute HF, as the definition is based on markers strongly influenced by inflammation and potentially by plasma volume status. The main goals of this study are to assess the variation of iron status and determine whether current ID definition is adequate to identify patients for correction at discharge.</p> <p><strong>Methods: </strong>This is a prospective multicenter study involving tertiary referral hospitals. Patients were assessed for inclusion if they were aged ≥18 years with “wet and warm” decompensated HF, as per European Society of Cardiology guidelines, and increased natriuretic peptides. The main exclusion criteria were recent iron or erythropoietin intake, increased inflammation (i.e., C-reactive protein >5mg/dL or infection) and significant hemorrhage. Iron status and clinical signs of congestion were assessed at enrollment, discharge (euvolemia) and 2-4 weeks after discharge (reevaluation). A single-center 3-month preliminary results are here reported.</p> <p><strong>Results: </strong>A total of 22 patients were included in this analysis. Mean age was 70,6 ± 14,2 years, most were male (54,5%) with ischemic (36,4%) or hypertensive (40,9%) HF. Mean LVEF was 44,4 ± 17,8%. ID had a tendency to decrease from enrollment to discharge (68,1% vs 33,3%; p=0,07) but not from discharge to reevaluation (33,3% vs 37,5%; p=1,000). Ferritin, TSAT and serum iron were significantly higher from enrollment to discharge (p=0,013; p=0,017; p=0,005, respectively), as were sodium and hemoglobin (p=0,037; p=0,016), and stable 2-4 weeks later (all p≥0,05). Additionally, weight, urea and NT-proBNP were significantly lower from enrollment to discharge (p=0,001; p=0,014; p=0,005, respectively) and stable from discharge to reevaluation (all p≥0,05).</p> <p><strong>Conclusions: </strong>Iron status in HF patients is strongly influenced by congestion. ID prevalence has a tendency to be overestimated in acute decompensated HF. Current definition appears to be appropriate with euvolemia, thus implying that ID identification and ensuing correction could be adequate at discharge. These preliminary results may be further strengthened with increasing enrollment.</p>
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