Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients

作者：Beverborg Niels Grote; Klip IJ**rand T; Meijers Wouter C; Voors Adriaan A; Vegter Eline L; van der Wal Haye H^*; Swinkels Dorine W; van Pelt Joost; Mulder Andre B; Bulstra Sjoerd K; Vellenga Edo; Mariani Massimo A; de Boer Rudolf A; van Veldhuisen Dirk J; van der Meer Peter^*

来源：Circulation-Heart Failure, 2018, 11(2): e004519.

DOI：10.1161/CIRCHEARTFAILURE.117.004519

• bone marrow
• ferric carboxymaltose
• ferritin
• heart failure
• prognosis
• transferrin saturation

BACKGROUND: The most commonly used definition of iron deficiency (ID; ferritin <100 ng/mL or ferritin 100-300 ng/mL and transferrin saturation [TSAT] <20%) has not been validated in patients with heart failure (HF). We aimed to define and validate the biomarker-based definition of ID in HF, using bone marrow iron staining as the gold standard. Second, we aimed to assess the prognostic value of the optimized definition.
METHODS AND RESULTS: Bone marrow aspiration with iron staining was performed in 42 patients with HF and a reduced left ventricular ejection fraction (<= 45%) undergoing median sternotomy for coronary artery bypass grafting. Patients were mostly male (76%) with mild-to-moderate HF and a mean age of 68 +/- 10 years. Bone marrow ID was found in 17 (40%) of the HF patients. The most commonly used definition of ID had a sensitivity of 82% and a specificity of 72%. A definition solely based on TSAT <= 19.8% or serum iron <= 13 mu mol/L had a sensitivity of 94% and specificity of 84% and 88%, respectively (P<0.05 compared with the former definition). Subsequently, we assessed the incidence of all-cause mortality in 387 consecutive outpatient HF patients (left ventricular ejection fraction <= 45%). In these patients, TSAT <= 19.8% and serum iron <= 13 mu mol/L, and not ferritin, were independently associated with mortality.
CONCLUSIONS: A TSAT <= 19.8% or a serum iron <= 13 mu mol/L shows the best performance in selecting patients with ID and identifies HF patients at the highest risk of death. Our findings validate the currently used TSAT cutoff of < 20% for the identification of ID in HF patients, but question the diagnostic value of ferritin.

• 出版日期2018-2