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. 2020 Nov 7:2020:8885189.
doi: 10.1155/2020/8885189. eCollection 2020.

Accurate Noninvasive Assessment of Myocardial Iron Load in Advanced Heart Failure Patients

Przemysław Leszek  1 , Barbara Sochanowicz  2 , Kamil Brzóska  2 , Leszek Kraj  3 , Mariusz Kuśmierczyk  1 , Witold Śmigielski  1 , Tomasz M Rywik  1 , Małgorzata Sobieszczańska-Małek  1 , Piotr Rozentryt  4   5 , Marcin Kruszewski  2   6
Affiliations

Accurate Noninvasive Assessment of Myocardial Iron Load in Advanced Heart Failure Patients

Przemysław Leszek et al. Dis Markers. .

Abstract

Background: Heart failure patients presenting with iron deficiency can benefit from systemic iron supplementation; however, there is the potential for iron overload to occur, which can seriously damage the heart. Therefore, myocardial iron (M-Iron) content should be precisely balanced, especially in already failing hearts. Unfortunately, the assessment of M-Iron via repeated heart biopsies or magnetic resonance imaging is unrealistic, and alternative serum markers must be found. This study is aimed at assessing M-Iron in patients with advanced heart failure (HF) and its association with a range of serum markers of iron metabolism.

Methods: Left ventricle (LV) myocardial biopsies and serum samples were collected from 33 consecutive HF patients (25 males) with LV dysfunction (LV ejection fraction 22 (11) %; NT-proBNP 5464 (3308) pg/ml) during heart transplantation. Myocardial ferritin (M-FR) and soluble transferrin receptor (M-sTfR1) were assessed by ELISA, and M-Iron was determined by Instrumental Neutron Activation Analysis in LV biopsies. Nonfailing hearts (n = 11) were used as control/reference tissue. Concentrations of serum iron-related proteins (FR and sTfR1) were assessed.

Results: LV M-Iron load was reduced in all HF patients and negatively associated with M-FR (r = -0.37, p = 0.05). Of the serum markers, sTfR1/logFR correlated with (r = -0.42; p = 0.04) and predicted (in a step-wise analysis, R 2 = 0.18; p = 0.04) LV M-Iron. LV M-Iron load (μg/g) can be calculated using the following formula: 210.24-22.869 × sTfR1/logFR.

Conclusions: The sTfR1/logFR ratio can be used to predict LV M-Iron levels. Therefore, serum FR and sTfR1 levels could be used to indirectly assess LV M-Iron, thereby increasing the safety of iron repletion therapy in HF patients.

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Conflict of interest statement

There are no potential conflicts of interest, including related consultancies, shareholdings, and funding grants.

Figures

Figure 1
Figure 1
Independent predictors of myocardial iron load (M-Iron) (in failing left ventricle). LV M-Iron: left ventricle myocardial iron load; sTfR1/log FR: serum soluble transferrin receptor 1/log ferritin.
See this image and copyright information in PMC

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