Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives

Abstract

Iron is a micronutrient essential for cellular energy and metabolism, necessary for maintaining body homoeostasis. Iron deficiency is an important co-morbidity in patients with heart failure (HF). A major factor in the pathogenesis of anaemia, it is also a separate condition with serious clinical consequences (e.g. impaired exercise capacity) and poor prognosis in HF patients. Experimental evidence suggests that iron therapy in iron-deficient animals may activate molecular pathways that can be cardio-protective. Clinical studies have demonstrated favourable effects of i.v. iron on the functional status, quality of life, and exercise capacity in HF patients. It is hypothesized that i.v. iron supplementation may become a novel therapy in HF patients with iron deficiency.

Figure 1

Importance of iron for functioning and survival across all levels of complexity of living structures.

Figure 2

Major pools of utilized and stored iron in the body.

Figure 3

The concept of absolute and functional iron deficiency.

Figure 4

Tissues utilizing and/or storing iron and related biomarkers which are secreted by these tissues and can be detected in peripheral blood.

Figure 5

Kaplan–Meier curves reflecting 3-year event-free survival rates in 546 patients with systolic heart failure with vs. without iron deficiency.

Figure 6

Self-reported Patient Global Assessment and NYHA functional class at week 24 (primary endpoints of FAIR-HF trial), according to assigned study treatment (intravenous iron vs. placebo).