Iron deficiency and red cell indices in patients with heart failure

Michał Tkaczyszyn, Josep Comín-Colet, Adriaan A. Voors, Dirk J. van Veldhuisen, Cristina Enjuanes, Pedro Moliner-Borja, Piotr Rozentryt, Lech Poloński, Waldemar Banasiak, Piotr Ponikowski, Peter van der Meer, Ewa A. Jankowska

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    © 2017 The Authors. European Journal of Heart Failure © 2017 European Society of Cardiology 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.
    Original languageEnglish
    Pages (from-to)114-122
    JournalEuropean Journal of Heart Failure
    Issue number1
    Publication statusPublished - 1 Jan 2018


    • Anaemia
    • Complete blood count
    • Heart failure
    • Iron deficiency
    • Red cell indices


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