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Review
. 2023 Jan 13;13(2):304.
doi: 10.3390/diagnostics13020304.

Role of Iron Deficiency in Heart Failure-Clinical and Treatment Approach: An Overview

Cristina Elena Singer  1 , Corina Maria Vasile  2 , Mihaela Popescu  3 , Alin Iulian Silviu Popescu  4 , Iulia Cristina Marginean  5 , George Alexandru Iacob  5 , Mihai Daniel Popescu  5 , Cristina Maria Marginean  4
Affiliations
Review

Role of Iron Deficiency in Heart Failure-Clinical and Treatment Approach: An Overview

Cristina Elena Singer et al. Diagnostics (Basel). .

Abstract

Background: The association of chronic heart failure (CHF) and iron deficiency (ID) with or without anemia is frequently encountered in current medical practice and has a negative prognostic impact, worsening patients' exercise capacity and increasing hospitalization costs. Moreover, anemia is common in patients with chronic kidney disease (CKD) and CHF, an association known as cardio-renal anemia syndrome (CRAS) possessing a significantly increased risk of death.

Aim: This review aims to provide an illustrative survey on the impact of ID in CHF patients-based on physiopathological traits, clinical features, and the correlation between functional and absolute ID with CHF-and the benefit of iron supplementation in CHF.

Method: We selected the most recent publications with important scientific content covering the association of CHF and ID with or without anemia.

Discussions: An intricate physiopathological interplay is described in these patients-decrease in erythropoietin levels, activation of the renin-angiotensin-aldosterone system, systemic inflammation, and increases in hepcidin levels. These mechanisms amplify anemia, CHF, and CKD severity and worsen patients' outcomes.

Conclusions: Anemia is frequently encountered in CHF and represents a negative prognostic factor. Data from randomized controlled trials have underlined the administration of intravenous iron therapy (ferric carboxymaltose) as the only viable treatment option, with beneficial effects on quality of life and exercise capacity in patients with ID and systolic heart failure.

Keywords: chronic heart failure; hemoglobin; iron deficiency anemia.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Therapeutical agents used in CHF management and their pathogenic mechanisms. ARB, angiotensin receptor blockers. ACE, angiotensin-converting enzyme. AcSDKP, N-Acetyl-Seryl-Aspartyl-Lysyl-Proline. ↑ = elevated value.
Figure 2
Figure 2
Physiopathology of cardio-renal anemia syndrome. EPO, erythropoietin. RAAS, renin-angiotensin-aldosterone system. ↑ = elevated value, ↓ = decreased value.
Figure 3
Figure 3
Therapeutical management of iron deficiency.
See this image and copyright information in PMC

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