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Ding Y, Zhang Y, Gao X, Hua C, Liu L, Huang D. Association of Iron Therapy with Mortality in Patients with Acute Myocardial Infarction and Iron Deficiency. Cardiovasc Toxicol 2024:10.1007/s12012-024-09905-x. [PMID: 39093536 DOI: 10.1007/s12012-024-09905-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 07/21/2024] [Indexed: 08/04/2024]
Abstract
Iron deficiency (ID) is common in patients with acute myocardial infarction (AMI). It is unknown whether patients with AMI combined with ID will benefit from iron supplementation therapy. This study aimed to assess the relationship between iron therapy and mortality in AMI patients. Retrospective analysis was performed in subjects screened from the Medical Information Mart in Intensive Care-IV database. The data were obtained from ICU patients admitted to Beth Israel Deaconess Medical Center between 2008 and 2019. The patients were divided into two groups according to iron treatment exposure. Propensity score matching (PSM) was performed in the original cohort at a 1:1 ratio. Univariate and multivariate analyses were performed to adjust for confounding factors. The primary outcome was 28-day mortality. A total of 426 patients were included in this study. After 1:1 PSM, 208 patients were analyzed. Iron treatment was associated with a lower risk of 28-day mortality (9 deaths (8.65%) in the iron treatment group vs. 21 deaths (20.19%) in the non-iron treatment group; HR = 0.39; 95% CI = 0.17-0.89; p = 0.025) and in-hospital mortality (4 deaths (3.85%) in the iron treatment group vs. 12 deaths (11.54%) in the non-iron treatment group; OR, 0.15; 95% CI, 0.03-0.74; p = 0.029). Iron treatment was associated with reduced 28-day mortality in patients with AMI combined with ID. Iron treatment had no significant effect on the length of hospitalization or the length of ICU stay. Prospective studies are needed to verify this conclusion.
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Affiliation(s)
- Ye Ding
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yiyan Zhang
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Xin Gao
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Chang Hua
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Linsheng Liu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
| | - Dan Huang
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
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Jenča D, Melenovský V, Mrázková J, Šramko M, Kotrč M, Želízko M, Adámková V, Piťha J, Kautzner J, Wohlfahrt P. Iron deficiency and all-cause mortality after myocardial infarction. Eur J Intern Med 2024; 126:102-108. [PMID: 38697863 DOI: 10.1016/j.ejim.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/19/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND Data on the clinical significance of iron deficiency (ID) in patients with myocardial infarction (MI) are conflicting. This may be related to the use of various ID criteria. We aimed to compare the association of different ID criteria with all-cause mortality after MI. METHODS Consecutive patients hospitalized for their first MI at a large tertiary heart center were included. We evaluated the association of different iron metabolism parameters measured on the first day after hospital admission with all-cause mortality. RESULTS From the 1,156 patients included (aged 64±12 years, 25 % women), 194 (16.8 %) patients died during the median follow-up of 3.4 years. After multivariate adjustment, iron level ≤13 µmol/L (HR 1.67, 95 % CI 1.19-2.34) and the combination of iron level ≤12.8 µmol/L and soluble transferrin receptor (sTfR) ≥3 mg/L (HR 2.56, 95 % CI 1.64-3.99) termed as PragueID criteria were associated with increased mortality risk and had additional predictive value to the GRACE score. Compared to the model including iron level, the addition of sTfR improved risk stratification (net reclassification improvement 0.61, 95 % CI 0.52-0.69) by reclassifying patients into a higher-risk group. No association between ferritin level and mortality was found. 51 % of patients had low iron levels, and 58 % fulfilled the PragueID criteria. CONCLUSION Iron deficiency is common among patients with the first MI. The PragueID criteria based on iron and soluble transferrin receptor levels provide the best prediction of mortality and should be evaluated in future interventional studies for the identification of patients potentially benefiting from intravenous iron therapy.
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Affiliation(s)
- Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic; Third Medical School, Charles University, Prague, Czech Republic
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jolana Mrázková
- Experimental Medicine Centre, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Marek Šramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic; First Medical School, Charles University, Prague, Czech Republic
| | - Martin Kotrč
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Michael Želízko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Piťha
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic; Medical and Dentistry School, Palacký University, Olomouc, Czech Republic
| | - Peter Wohlfahrt
- First Medical School, Charles University, Prague, Czech Republic; Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Corradi F, Masini G, Bucciarelli T, De Caterina R. Iron deficiency in myocardial ischaemia: molecular mechanisms and therapeutic perspectives. Cardiovasc Res 2023; 119:2405-2420. [PMID: 37722377 DOI: 10.1093/cvr/cvad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/14/2023] [Accepted: 07/10/2023] [Indexed: 09/20/2023] Open
Abstract
Systemic iron deficiency (SID), even in the absence of anaemia, worsens the prognosis and increases mortality in heart failure (HF). Recent clinical-epidemiological studies, however, have shown that a myocardial iron deficiency (MID) is frequently present in cases of severe HF, even in the absence of SID and without anaemia. In addition, experimental studies have shown a poor correlation between the state of systemic and myocardial iron. MID in animal models leads to severe mitochondrial dysfunction, alterations of mitophagy, and mitochondrial biogenesis, with profound alterations in cardiac mechanics and the occurrence of a fatal cardiomyopathy, all effects prevented by intravenous administration of iron. This shifts the focus to the myocardial state of iron, in the absence of anaemia, as an important factor in prognostic worsening and mortality in HF. There is now epidemiological evidence that SID worsens prognosis and mortality also in patients with acute and chronic coronary heart disease and experimental evidence that MID aggravates acute myocardial ischaemia as well as post-ischaemic remodelling. Intravenous administration of ferric carboxymaltose (FCM) or ferric dextrane improves post-ischaemic adverse remodelling. We here review such evidence, propose that MID worsens ischaemia/reperfusion injury, and discuss possible molecular mechanisms, such as chronic hyperactivation of HIF1-α, exacerbation of cytosolic and mitochondrial calcium overload, amplified increase of mitochondrial [NADH]/[NAD+] ratio, and depletion of energy status and NAD+ content with inhibition of sirtuin 1-3 activity. Such evidence now portrays iron metabolism as a core factor not only in HF but also in myocardial ischaemia.
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Affiliation(s)
- Francesco Corradi
- Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Gabriele Masini
- Chair and Postgraduate School of Cardiology, University of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Tonino Bucciarelli
- Department of Medicine and Aging Sciences, "G. D'Annunzio" University of Chieti-Pescara, Via dei Vestini, 66100, Chieti, Italy
| | - Raffaele De Caterina
- Chair and Postgraduate School of Cardiology, University of Pisa, Via Savi 10, 56126, Pisa, Italy
- Fondazione VillaSerena per la Ricerca, Viale L. Petruzzi 42, 65013, Città Sant'Angelo, Pescara, Italy
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Chung B, Wang Y, Thiel M, Rostami F, Rogoll A, Hirsch VG, Malik Z, Bührke A, Bär C, Klintschar M, Schmitto JD, Vogt C, Werlein C, Jonigk D, Bauersachs J, Wollert KC, Kempf T. Pre-emptive iron supplementation prevents myocardial iron deficiency and attenuates adverse remodelling after myocardial infarction. Cardiovasc Res 2023; 119:1969-1980. [PMID: 37315201 DOI: 10.1093/cvr/cvad092] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 03/20/2023] [Accepted: 04/08/2023] [Indexed: 06/16/2023] Open
Abstract
AIMS Heart failure (HF) after myocardial infarction (MI) is a major cause of morbidity and mortality. We sought to investigate the functional importance of cardiac iron status after MI and the potential of pre-emptive iron supplementation in preventing cardiac iron deficiency (ID) and attenuating left ventricular (LV) remodelling. METHODS AND RESULTS MI was induced in C57BL/6J male mice by left anterior descending coronary artery ligation. Cardiac iron status in the non-infarcted LV myocardium was dynamically regulated after MI: non-haem iron and ferritin increased at 4 weeks but decreased at 24 weeks after MI. Cardiac ID at 24 weeks was associated with reduced expression of iron-dependent electron transport chain (ETC) Complex I compared with sham-operated mice. Hepcidin expression in the non-infarcted LV myocardium was elevated at 4 weeks and suppressed at 24 weeks. Hepcidin suppression at 24 weeks was accompanied by more abundant expression of membrane-localized ferroportin, the iron exporter, in the non-infarcted LV myocardium. Notably, similarly dysregulated iron homeostasis was observed in LV myocardium from failing human hearts, which displayed lower iron content, reduced hepcidin expression, and increased membrane-bound ferroportin. Injecting ferric carboxymaltose (15 µg/g body weight) intravenously at 12, 16, and 20 weeks after MI preserved cardiac iron content and attenuated LV remodelling and dysfunction at 24 weeks compared with saline-injected mice. CONCLUSION We demonstrate, for the first time, that dynamic changes in cardiac iron status after MI are associated with local hepcidin suppression, leading to cardiac ID long term after MI. Pre-emptive iron supplementation maintained cardiac iron content and attenuated adverse remodelling after MI. Our results identify the spontaneous development of cardiac ID as a novel disease mechanism and therapeutic target in post-infarction LV remodelling and HF.
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Affiliation(s)
- Bomee Chung
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Yong Wang
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Marleen Thiel
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Fatemeh Rostami
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Anika Rogoll
- Institute for Analytical Chemistry, TU Bergakademie, Leipziger Straße 29, 09599 Freiberg, Germany
| | - Valentin G Hirsch
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Zulaikha Malik
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Anne Bührke
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Christian Bär
- Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Michael Klintschar
- Institute of Forensic Medicine, Hannover Medical School, Carl-Neuberger-Straße 1, 30625 Hannover, Germany
| | - Jan D Schmitto
- Department of Cardiac-, Thoracic-, Transplantation, and Vascular Surgery, Hannover Medical School, Carl-Neuberger-Straße 1, 30625 Hannover, Germany
| | - Carla Vogt
- Institute for Analytical Chemistry, TU Bergakademie, Leipziger Straße 29, 09599 Freiberg, Germany
| | - Christopher Werlein
- Institute of Pathology and German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover Medical School, Carl-Neuberger-Straße 1, 30625 Hannover, Germany
| | - Danny Jonigk
- Institute of Pathology and German Centre for Lung Research, Biomedical Research in End-stage and Obstructive Lung Disease Hannover, Hannover Medical School, Carl-Neuberger-Straße 1, 30625 Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Kai C Wollert
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
- Division of Molecular and Translational Cardiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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Nan Y, Tiemuerniyazi X, Song Y, Chen L, Yang Z, Zhang S, Feng W. Iron Deficiency Might Impair the Recovery of Left Ventricular Function after Surgical Revascularization in Diabetic Patients: A Retrospective Study. Rev Cardiovasc Med 2023; 24:209. [PMID: 39077024 PMCID: PMC11266479 DOI: 10.31083/j.rcm2407209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 07/31/2024] Open
Abstract
Background Iron deficiency (ID) is one of the most common micronutrient deficiencies affecting public health. Studies show that ID affects the prognosis of patients with heart disease, including heart failure, coronary artery disease and myocardial infarction. However, there is limited information regarding the impact of ID on patients undergoing cardiac surgery. This study aimed to evaluate the influence of preoperative ID on the prognosis of type 2 diabetes mellitus (T2DM) patients undergoing coronary artery bypass grafting (CABG). Methods In the Glycemic control using mobile-based intervention in patients with diabetes undergoing coronary artery bypass to promote self-management (GUIDEME) study, patients with T2DM undergoing CABG were prospectively recruited. In this study, only those patients with preoperative iron metabolism results were enrolled. Patients were grouped based on the presence of preoperative ID. The primary endpoint was defined as the significant improvement of follow-up ejection fraction (EF) compared to postoperative levels (classified according to the 75th percentile of the change, and defined as an improvement of greater than or equal to 5%). Univariable logistic regression was performed to explore the potential confounders, followed by multiple adjustment. Results A total of 302 patients were enrolled. No deaths were observed during the study period. A higher incidence of the primary endpoint was observed in the ID group (25.4% vs 12.9%, p = 0.015). The postoperative and follow-up EF were similar beween the two groups. In the regression analysis, ID was noticed to be a strong predictor against the significant improvement of EF in both univariable (odds ratio [OR]: 0.44, 95% confidence interval [CI]: 0.22-0.86, p = 0.017) and multivariable (OR: 0.43, 95% CI: 0.24-0.98, p = 0.043) logistic regression. In the subgroup analysis, ID was a predictor of significant improvement of EF in age ≤ 60 years, male, EF ≤ 60%, and on-pump CABG patients. Conclusions In T2DM patients undergoing CABG, ID might negatively affect the early recovery of left ventricular systolic function in terms of recovery of EF 3-6 months after surgery, especially in patients age ≤ 60 years, males, EF ≤ 60% and in those undergoing on-pump CABG.
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Affiliation(s)
- Yifeng Nan
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Xieraili Tiemuerniyazi
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Yangwu Song
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Liangcai Chen
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Ziang Yang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Shicheng Zhang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
| | - Wei Feng
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
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Liu F, Liu Y, Xu S, Wang Q, Xu F, Liu Y. Mendelian randomization study reveals a causal relationship between serum iron status and coronary heart disease and related cardiovascular diseases. Front Cardiovasc Med 2023; 10:1152201. [PMID: 37383700 PMCID: PMC10294586 DOI: 10.3389/fcvm.2023.1152201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Abstract
Background Growing observational studies have shown that abnormal systemic iron status is associated with Coronary heart disease (CHD). However, these results from observational studies was not entirely consistent.It remains unclear whether this relationship represents causality.It is necessary to explore the causal relationship between iron status and CHD and related cardiovascular diseases (CVD). Objective We aimed to investigate the potential casual relationship between serum iron status and CHD and related CVD using a two-sample Mendelian randomization (MR) approach. Methods Genetic statistics for single nucleotide polymorphisms (SNPs) between four iron status parameters were identified in a large-scale genome-wide association study (GWAS) conducted by the Iron Status Genetics organization. Three independent single nucleotide polymorphisms (SNPs) (rs1800562, rs1799945, and rs855791) aligned with four iron status biomarkers were used as instrumental variables. CHD and related CVD genetic statistics We used publicly available summary-level GWAS data. Five different MR methods random effects inverse variance weighting (IVW), MR Egger, weighted median, weighted mode, and Wald ratio were used to explore the causal relationship between serum iron status and CHD and related CVD. Results In the MR analysis, we found that the causal effect of serum iron (OR = 0.995, 95% CI = 0.992-0.998, p = 0.002) was negatively associated with the odds of coronary atherosclerosis (AS). Transferrin saturation (TS) (OR = 0.885, 95% CI = 0.797-0.982, p = 0.02) was negatively associated with the odds of Myocardial infarction (MI). Conclusion This MR analysis provides evidence for a causal relationship between whole-body iron status and CHD development. Our study suggests that a high iron status may be associated with a reduced risk of developing CHD.
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Affiliation(s)
- Fenglan Liu
- The Second Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- School of Clinical Medicine, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yanfei Liu
- The Second Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shihan Xu
- The Second Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Qing Wang
- The Second Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Fengqin Xu
- The Second Department of Geriatrics, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yue Liu
- National Clinical Research Center for TCM Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Kapoor PM, Prakash M, Mujahid OM. suPAR as a risk Prediction Biomarker in Extracorporeal Membrane Oxygenation. JOURNAL OF CARDIAC CRITICAL CARE TSS 2023. [DOI: 10.25259/jccc_5_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
suPAR is a promising biomarker of cardiovascular diseases, as it reflects “low-grade inflammation” and is associated with lifestyle factors such as smoking, alcohol, and an inactive lifestyle. suPAR is expressed in various cells involved in the development of atherosclerosis, including macrophages, endothelial cells, and smooth muscle cells, and an accumulation of suPAR in the atheroma has also been found. suPAR plays a role in the coagulation cascade during plasminogen activation and fibrinolysis. This abstract provides description of three case series showing the utility of suPAR as a risk prediction biomarker on VA extracorporeal membrane oxygenation (ECMO). We used SUPAR in 15 patients undergoing cardiac surgery of which three went on VA ECMO. Herein, we describe in detail three such patients and discuss each with good review of the literature.
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Affiliation(s)
| | - Mohit Prakash
- Department of Cardiac Anesthesia and Critical Care, AIIMS, New Delhi, India,
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Role of Iron Deficiency in Heart Failure-Clinical and Treatment Approach: An Overview. Diagnostics (Basel) 2023; 13:diagnostics13020304. [PMID: 36673114 PMCID: PMC9857585 DOI: 10.3390/diagnostics13020304] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
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.
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Wohlfahrt P, Jenča D, Stehlik J, Melenovský V, Mrázková J, Staněk V, Kettner J, Šramko M, Želízko M, Adámková V, Piťha J, Kautzner J. Heart failure-related quality-of-life impairment after myocardial infarction. Clin Res Cardiol 2023; 112:39-48. [PMID: 35304902 DOI: 10.1007/s00392-022-02008-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 03/07/2022] [Indexed: 01/21/2023]
Abstract
AIMS Recent advances in therapy led to a significant decrease in mortality and morbidity after myocardial infarction (MI). However, little is known about quality of life (QoL) after MI. We examined heart failure (HF)-related quality-of-life (QoL) impairment, its trajectories, and determinants after MI. METHODS Data from a single-center prospectively designed registry of consecutive patients hospitalized for MI at a large tertiary cardiology center were utilized. At 1 month and 1 year after hospital discharge, patients completed the Kansas City Cardiomyopathy Questionnaire (KCCQ). RESULTS In total, 850 patients (aged 65 ± 12 years, 27% female) hospitalized between June 2017 and October 2020 completed KCCQ at 1 month after discharge. Of these, 38.7% showed HF-related QoL impairment (KCCQ ≤ 75). In addition to characteristics of MI (MI size, diuretics need, heart rate), comorbidities as renal dysfunction and anemia were associated with QoL impairment. Of the 673 eligible, 500 patients (74.3%) completed KCCQ at 1 year after MI. On average, QoL improved by 5.9 ± 16.8 points during the first year after MI (p < 0.001); but, in 18% of patients QoL worsened. Diabetes control and hemoglobin level at the time of hospitalization were associated with QoL worsening. CONCLUSION Two out of 5 patients after MI present with HF-related QoL impairment. In addition to guideline-directed MI management, careful attention to key non-cardiac comorbidities as chronic kidney disease, anemia and diabetes may lead to further augmentation of the benefit of modern therapies in terms of QoL.
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Affiliation(s)
- Peter Wohlfahrt
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. .,Center for Cardiovascular Prevention, Charles University in Prague, First Faculty of Medicine and Thomayer Hospital, Videnska 800, 140 59, Prague, Czech Republic.
| | - Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Stehlik
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jolana Mrázková
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Vladimír Staněk
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Jiří Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Marek Šramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Michael Želízko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jan Piťha
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czech Republic
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Savarese G, von Haehling S, Butler J, Cleland JGF, Ponikowski P, Anker SD. Iron deficiency and cardiovascular disease. Eur Heart J 2023; 44:14-27. [PMID: 36282723 PMCID: PMC9805408 DOI: 10.1093/eurheartj/ehac569] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/11/2022] [Accepted: 09/27/2022] [Indexed: 02/07/2023] Open
Abstract
Iron deficiency (ID) is common in patients with cardiovascular disease. Up to 60% of patients with coronary artery disease, and an even higher proportion of those with heart failure (HF) or pulmonary hypertension have ID; the evidence for cerebrovascular disease, aortic stenosis and atrial fibrillation is less robust. The prevalence of ID increases with the severity of cardiac and renal dysfunction and is probably more common amongst women. Insufficient dietary iron, reduced iron absorption due to increases in hepcidin secondary to the low-grade inflammation associated with atherosclerosis and congestion or reduced gastric acidity, and increased blood loss due to anti-thrombotic therapy or gastro-intestinal or renal disease may all cause ID. For older people in the general population and patients with HF with reduced ejection fraction (HFrEF), both anaemia and ID are associated with a poor prognosis; each may confer independent risk. There is growing evidence that ID is an important therapeutic target for patients with HFrEF, even if they do not have anaemia. Whether this is also true for other HF phenotypes or patients with cardiovascular disease in general is currently unknown. Randomized trials showed that intravenous ferric carboxymaltose improved symptoms, health-related quality of life and exercise capacity and reduced hospitalizations for worsening HF in patients with HFrEF and mildly reduced ejection fraction (<50%). Since ID is easy to treat and is effective for patients with HFrEF, such patients should be investigated for possible ID. This recommendation may extend to other populations in the light of evidence from future trials.
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Affiliation(s)
- Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
- Baylor Scott and White Research Institute, Dallas TX, USA
| | - John G F Cleland
- Robertson Centre for Biostatistics and Clinical Trials, Institute of Health & Wellebing, University of Glasgow, Glasgow, UK
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Piotr Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Wrocław, Poland
- Centre for Heart Diseases, University Hospital, Wroclaw, Poland
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11
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Szklarz M, Gontarz-Nowak K, Matuszewski W, Bandurska-Stankiewicz E. Can Iron Play a Crucial Role in Maintaining Cardiovascular Health in the 21st Century? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11990. [PMID: 36231287 PMCID: PMC9565681 DOI: 10.3390/ijerph191911990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 06/16/2023]
Abstract
In the 21st century the heart is facing more and more challenges so it should be brave and iron to meet these challenges. We are living in the era of the COVID-19 pandemic, population aging, prevalent obesity, diabetes and autoimmune diseases, environmental pollution, mass migrations and new potential pandemic threats. In our article we showed sophisticated and complex regulations of iron metabolism. We discussed the impact of iron metabolism on heart diseases, treatment of heart failure, diabetes and obesity. We faced the problems of constant stress, climate change, environmental pollution, migrations and epidemics and showed that iron is really essential for heart metabolism in the 21st century.
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12
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Sagaydak OV, Oschepkova EV, Chazova IE. Seх differences in treatment of acute coronary syndrome patients. Data from federal registry of acute coronary syndrome 2016–2019. TERAPEVT ARKH 2022; 94:797-802. [DOI: 10.26442/00403660.2022.07.201732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/05/2022] [Indexed: 11/22/2022]
Abstract
Introduction. Management of patients with acute coronary syndrome (ACS) is usually universal, regardless of gender, age, and ethnicity. But often in practice, gender and age influence medical decisions, and patients do not receive proper medical care. Medical care for patients with ACS was analyzed by gender according to the federal register of ACS data.
Aim. To analyze the influence of the patient's gender on the course of the disease and on the provision of medical care to patients with ACS who underwent treatment in 20162019.
Materials and methods. The data of 95 586 cases was analyzed. Two groups were identified: men (n=59 442, 62.2%) and women (n=36 144, 57.8%).
Results. Anamnesis analysis has revealed, that women were often more burdened with concomitant diseases and had a higher risk on the GRACE scale at admission. It was demonstrated that men underwent revascularization on average significantly more often than women (51.9% versus 32.5%, respectively, p0.001). In women, conservative therapy was more. When compared with the appropriate use criteria for coronary revascularization, it was shown that more than 70% of women in whom a conservative treatment strategy was chosen, it was expedient to undergo myocardial revascularization using percutaneous coronary intervention.
Conclusion. Gender differences were revealed in the course of the disease, as well as in the choice of treatment by doctors. Women are characterized by a later manifestation of the disease, more often in the form of ST-ACS. The course of the disease in women is associated with a higher comorbidity, atypical symptoms and later call for help. A conservative approach prevails in the choice of ACS treatment tactics in women.
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13
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VENTURINI E, IANNUZZO G, DI LORENZO A, CUOMO G, D'ANGELO A, MERONE P, CUDEMO G, PACILEO M, D'ANDREA A, VIGORITO C, GIALLAURIA F. Short-term treatment of iron deficiency anemia after cardiac surgery. IJC HEART & VASCULATURE 2022; 40:101038. [PMID: 35514874 PMCID: PMC9066354 DOI: 10.1016/j.ijcha.2022.101038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
Iron deficiency anemia (IDA) is frequent after cardiac surgery and is associated with increased morbidity and mortality. In a retrospective study, we analyzed 106 patients with IDA (hemoglobin [Hb] ≤ 12 g/dl in women and ≤ 13 g/dl in men, transferrin saturation [TSAT] ≤ 20%) on admission to a Cardiac Rehabilitation Unit after cardiac surgery. The patients were divided into two groups, one was treated with oral sucrosomial iron (SI) and the other with intravenous ferric carboxymaltose (FCM). Patients received a single 1000 mg dose of FCM from the day after admission to rehabilitation (T1), or a 120 mg/day dose of SI from T1 until discharge (T2); after discharge, SI was reduced to 30 mg/day until the end of follow-up (T3). Hb was evaluated at T1, T2 and T3; the other hematological parameters at T1 and T3; natriuretic peptides at T1, T2 and T3; 6-minute walk test (6MWT) at T1 and T2. Folate, vitamin B12 and reticulocytes were sampled on admission. Folate deficiency was documented in 60.4% of patients. Hb increased in both groups with no significant differences between the two treatments (p = 0.397). The other iron metabolism parameters (sideremia, transferrin, TSAT) displayed similar behavior, showing a significant increase at T3 (p < 0.001) with both therapies, although the increase was faster with FCM. Ferritin – high on admission – decreased at T3 in the SI group and rose significantly in the FCM group (SI 219.5 vs. FCM 689 ng/ml p < 0.0001). The 6MWT increased significantly at T2, with an overlap between SI and FCM. In conclusion, the results of this study show that SI and FCM exhibit the same effectiveness on IDA; the response time to therapy of both treatments is also equally fast. SI and FCM induce a similar increase in functional capacity. The study shows that SI can be a viable alternative to FCM after cardiac surgery in terms of effectiveness and tolerability.
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Affiliation(s)
- Elio VENTURINI
- Cardiac Rehabilitation Unit and Department of Cardiology, Azienda USL Toscana Nord-Ovest, “Cecina Civil Hospital”, 57023 - Cecina (LI), Italy
| | - Gabriella IANNUZZO
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 – Naples, Italy
| | - Anna DI LORENZO
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
| | - Gianluigi CUOMO
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
| | - Andrea D'ANGELO
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
| | - Pasquale MERONE
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
| | - Giuseppe CUDEMO
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
| | - Mario PACILEO
- Department of Cardiology and Intensive Coronary Care, “Umberto I Hospital”, 84014 - Nocera Inferiore (SA), Italy
| | - Antonello D'ANDREA
- Department of Cardiology and Intensive Coronary Care, “Umberto I Hospital”, 84014 - Nocera Inferiore (SA), Italy
| | - Carlo VIGORITO
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
| | - Francesco GIALLAURIA
- Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, 80131 – Naples, Italy
- Corresponding author at: Department of Translational Medical Sciences, Division of Internal Medicine and Cardiac Rehabilitation, “Federico II” University of Naples, Naples, Italy.
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14
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Effects of Iron Supplementation on Testicular Function and Spermatogenesis of Iron-Deficient Rats. Nutrients 2022; 14:nu14102063. [PMID: 35631204 PMCID: PMC9144601 DOI: 10.3390/nu14102063] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 01/27/2023] Open
Abstract
Iron deficiency is the most common micronutrient deficiency in the world. Previous studies have shown that iron deficiency increases oxidative stress and decreases antioxidant enzymes, and studies of male infertility indicated that oxidative stress may affect male reproductive functions. The aim of this study was to investigate the effects of iron supplementation on spermatogenesis and testicular functions in iron-deficient rats. Three-week-old male Sprague Dawley (SD) rats were randomly divided into two groups: an iron-adequate control (AI group, 35 ppm FeSO4) and an iron-deficient group (ID group, <5 ppm FeSO4). After three weeks, the iron-deficient group was divided into an original iron-deficient group and five iron-supplemented groups, the latter fed diets containing different doses of FeSO4 (6, 12, 18, 24, and 35 ppm). After five weeks, blood and testis tissue were analyzed. We presented as median (interquartile range, IQR) for continuous measurements and compared their differences using the Kruskal−Wallis test followed by the Mann−Whitney U test among groups. The results showed that as compared with the AI group, the ID group had significantly lower serum testosterone and poorer spermatogenesis (The medians (QR) were 187.4 (185.6−190.8) of AI group vs. 87.5 (85.7−90.4) of ID group in serum testosterone, p < 0.05; 9.3 (8.8−10.6) of AI group vs. 4.9 (3.4−5.4) of ID group in mean testicular biopsy score (MTBS], p < 0.05); iron supplementation reversed the impairment of testis tissue. In the testosterone biosynthesis pathway, iron supplementation improved the lowered protein expressions of hydroxysteroid dehydrogenases caused by iron deficiency. Additionally, decreased activities of glutathione peroxidase and catalase, and increased cleaved-caspase 8 and caspase 3 expression, were found in the iron-deficient rats. The iron-supplemented rats that received > 12 ppm FeSO4 exhibited improvements in antioxidant levels. In conclusion, iron supplementation can abrogate testis dysfunction due to iron deficiency through regulation of the testicular antioxidant capacity.
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15
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Gürgöze MT, Kardys I, Akkerhuis KM, Oemrawsingh RM, Groot HE, van der Harst P, Umans VA, Kietselaer B, Ronner E, Lenderink T, Asselbergs FW, Manintveld OC, Boersma E. Relation of Iron Status to Prognosis After Acute Coronary Syndrome. Am J Cardiol 2022; 168:22-30. [PMID: 35045937 DOI: 10.1016/j.amjcard.2021.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 02/08/2023]
Abstract
Iron deficiency has been extensively researched and is associated with adverse outcomes in heart failure. However, to our knowledge, the temporal evolution of iron status has not been previously investigated in patients with acute coronary syndrome (ACS). Therefore, we aimed to explore the temporal pattern of repeatedly measured iron, ferritin, transferrin, and transferrin saturation (TSAT) in relation to prognosis post-ACS. BIOMArCS (BIOMarker study to identify the Acute risk of a Coronary Syndrome) is a prospective, multicenter, observational cohort study conducted in The Netherlands between 2008 and 2015. A total of 844 patients with post-ACS were enrolled and underwent high-frequency (median 17) blood sampling during 1 year follow-up. Biomarkers of iron status were measured batchwise in a central laboratory. We analyzed 3 patient subsets, including the case-cohort (n = 187). The primary endpoint (PE) was a composite of cardiovascular mortality and repeat nonfatal ACS, including unstable angina pectoris requiring revascularization. The association between iron status and the PE was analyzed using multivariable joint models. Mean age was 63 years; 78% were men, and >50% had iron deficiency at first sample in the case-cohort. After adjustment for a broad range of clinical variables, 1 SD decrease in log-iron was associated with a 2.2-fold greater risk of the PE (hazard ratio 2.19, 95% confidence interval 1.34 to 3.54, p = 0.002). Similarly, 1 SD decrease in log-TSAT was associated with a 78% increased risk of the PE (hazard ratio 1.78, 95% confidence interval 1.17 to 2.65, p = 0.006). Ferritin and transferrin were not associated with the PE. Repeated measurements of iron and TSAT predict risk of adverse outcomes in patients with post-ACS during 1 year follow-up. Trial Registration: The Netherlands Trial Register. Unique identifiers: NTR1698 and NTR1106. Registered at https://www.trialregister.nl/trial/1614 and https://www.trialregister.nl/trial/1073.
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16
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Jayakumar D, S Narasimhan KK, Periandavan K. Triad role of hepcidin, ferroportin, and Nrf2 in cardiac iron metabolism: From health to disease. J Trace Elem Med Biol 2022; 69:126882. [PMID: 34710708 DOI: 10.1016/j.jtemb.2021.126882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022]
Abstract
Iron is an essential trace element required for several vital physiological and developmental processes, including erythropoiesis, bone, and neuronal development. Iron metabolism and oxygen homeostasis are interlinked to perform a vital role in the functionality of the heart. The metabolic machinery of the heart utilizes almost 90 % of oxygen through the electron transport chain. To handle this tremendous level of oxygen, the iron metabolism in the heart is utmost crucial. Iron availability to the heart is therefore tightly regulated by (i) the hepcidin/ferroportin axis, which controls dietary iron absorption, storage, and recycling, and (ii) iron regulatory proteins 1 and 2 (IRP1/2) via hypoxia inducible factor 1 (HIF1) pathway. Despite iron being vital to the heart, recent investigations have demonstrated that iron imbalance is a common manifestation in conditions of heart failure (HF), since free iron readily transforms between Fe2+ and Fe3+via the Fenton reaction, leading to reactive oxygen species (ROS) production and oxidative damage. Therefore, to combat iron-mediated oxidative stress, targeting Nrf2/ARE antioxidant signaling is rational. The involvement of Nrf2 in regulating several genes engaged in heme synthesis, iron storage, and iron export is beginning to be uncovered. Consequently, it is possible that Nrf2/hepcidin/ferroportin might act as an epicenter connecting iron metabolism to redox alterations. However, the mechanism bridging the two remains obscure. In this review, we tried to summarize the contemporary insight of how cardiomyocytes regulate intracellular iron levels and discussed the mechanisms linking cardiac dysfunction with iron imbalance. Further, we emphasized the impact of Nrf2 on the interplay between systemic/cardiac iron control in the context of heart disease, particularly in myocardial ischemia and HF.
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Affiliation(s)
- Deepthy Jayakumar
- Department of Medical Biochemistry, Dr. ALM Post Graduate Institute for Basic Medical Sciences, University of Madras, Chennai, 600113, Tamil Nadu, India
| | - Kishore Kumar S Narasimhan
- Department of Pharmacology and Neurosciences, Creighton University, 2500 California Plaza, Omaha, NE, USA
| | - Kalaiselvi Periandavan
- Department of Medical Biochemistry, Dr. ALM Post Graduate Institute for Basic Medical Sciences, University of Madras, Chennai, 600113, Tamil Nadu, India.
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17
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van Dalen DH, Kragten JA, Emans ME, van Ofwegen-Hanekamp CEE, Klaarwater CCR, Spanjers MHA, Hendrick R, van Deursen CTBM, Brunner-La Rocca HP. Acute heart failure and iron deficiency: a prospective, multicentre, observational study. ESC Heart Fail 2021; 9:398-407. [PMID: 34862747 PMCID: PMC8788059 DOI: 10.1002/ehf2.13737] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/11/2021] [Accepted: 11/11/2021] [Indexed: 01/10/2023] Open
Abstract
Aims The prevalence and the natural course of iron deficiency (ID) in acute heart failure (AHF) are still unclear. We investigated the prevalence of ID in unselected patients admitted with AHF on admission, at discharge and up to 3 months thereafter. Methods and results In this prospective, multicentre, observational study, 742 patients admitted with AHF were enrolled. The main study outcome was the percentage of patients with ID (ferritin <100 μg/L = absolute ID or ferritin 100–299 μg/L and transferrin saturation <20% = functional ID) at admission (T0), after clinical stabilization prior to discharge (T1), and 10 ± 6 weeks after discharge (T2). At T0, ID was present in 71.8% of the patients (44.1% absolute and 27.7% functional ID). At T1 and T2, ID was present in 56.4% (32.4% absolute and 24% functional ID) and 50.3% (36.8% absolute and 13.5% functional ID), respectively. Absolute ID persisted from T0 to T2 in 66% of the patients, while functional ID resolved in 56% of the patients. Ferritin (median [interquartile range] 124 μg/L [56–247] to 150 μg/L [73–277]), transferrin saturation (15% [10–20] to 18% [12–27]), and iron levels (9 μmol/L [6–13] to 11 μmol/L [8–16]) increased significantly (all P < 0.001) from T0 to T1. Transferrin saturation (to 21% [15–29]) and iron levels (to 13 μmol/L [9–17]) also increased significantly (both P < 0.01) from T1 to T2 without iron supplementation. Conclusions Iron deficiency is highly prevalent in patients with AHF, but resolves during treatment in some patients, even without iron supplementation. Absolute ID is more likely to persist over time, whereas functional ID often resolves during treatment of AHF, representing probably a reduced iron availability rather than a true deficiency.
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Affiliation(s)
- Dirk H van Dalen
- Department of Cardiology, Jeroen Bosch Hospital, PO Box 90153, room B4.02.022, 's-Hertogenbosch, 5200ME, The Netherlands
| | - Johannes A Kragten
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Mireille E Emans
- Department of Cardiology, Ikazia Hospital Rotterdam, Rotterdam, The Netherlands
| | | | | | - Mireille H A Spanjers
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rémond Hendrick
- Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Cees Th B M van Deursen
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands.,School of Cardiovascular Diseases (CARIM), University of Maastricht, Maastricht, The Netherlands
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18
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Schrage B, Rübsamen N, Ojeda FM, Thorand B, Peters A, Koenig W, Söderberg S, Söderberg M, Mathiesen EB, Njølstad I, Kee F, Linneberg A, Kuulasmaa K, Tarja P, Salomaa V, Blankenberg S, Zeller T, Karakas M. Association of iron deficiency with incident cardiovascular diseases and mortality in the general population. ESC Heart Fail 2021; 8:4584-4592. [PMID: 34610649 PMCID: PMC8712835 DOI: 10.1002/ehf2.13589] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 08/09/2021] [Accepted: 08/19/2021] [Indexed: 12/13/2022] Open
Abstract
Aims Although absolute (AID) and functional iron deficiency (FID) are known risk factors for patients with cardiovascular (CV) disease, their relevance for the general population is unknown. The aim was to assess the association between AID/FID with incident CV disease and mortality in the general population. Methods and results In 12 164 individuals from three European population‐based cohorts, AID was defined as ferritin < 100 μg/L or as ferritin < 30 μg/L (severe AID), and FID was defined as ferritin < 100 μg/L or ferritin 100–299 μg/L and transferrin saturation < 20%. The association between iron deficiency and incident coronary heart disease (CHD), CV mortality, and all‐cause mortality was evaluated by Cox regression models. Population attributable fraction (PAF) was estimated. Median age was 59 (45–68) years; 45.2% were male. AID, severe AID, and FID were prevalent in 60.0%, 16.4%, and 64.3% of individuals. AID was associated with CHD [hazard ratio (HR) 1.20, 95% confidence interval (CI) 1.04–1.39, P = 0.01], but not with mortality. Severe AID was associated with all‐cause mortality (HR 1.28, 95% CI 1.12–1.46, P < 0.01), but not with CV mortality/CHD. FID was associated with CHD (HR 1.24, 95% CI 1.07–1.43, P < 0.01), CV mortality (HR 1.26, 95% CI 1.03–1.54, P = 0.03), and all‐cause mortality (HR 1.12, 95% CI 1.01–1.24, P = 0.03). Overall, 5.4% of all deaths, 11.7% of all CV deaths, and 10.7% of CHD were attributable to FID. Conclusions In the general population, FID was highly prevalent, was associated with incident CHD, CV death, and all‐cause death, and had the highest PAF for these events, whereas AID was only associated with CHD and severe AID only with all‐cause mortality. This indicates that FID is a relevant risk factor for CV diseases in the general population.
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Affiliation(s)
- Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Nicole Rübsamen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Francisco M Ojeda
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Barbara Thorand
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health (GmbH), Neuherberg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Munich, Munich, Germany
| | - Wolfgang Koenig
- DZHK (German Center for Cardiovascular Research), partner site Munich, Munich, Germany.,Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Stefan Söderberg
- Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Umeå, Sweden
| | - Maja Söderberg
- Department of Public Health and Clinical Medicine, and Heart Centre, Umeå University, Umeå, Sweden
| | - Ellisiv B Mathiesen
- Department of Community Medicine, University of Tromsø The Arctic University of Norway, Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, University of Tromsø The Arctic University of Norway, Tromsø, Norway
| | - Frank Kee
- Centre for Public Health, Queens University of Belfast, Belfast, UK
| | - Allan Linneberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region, Copenhagen, Denmark
| | - Kari Kuulasmaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Palosaari Tarja
- National Institute for Health and Welfare, Helsinki, Finland
| | - Veikko Salomaa
- National Institute for Health and Welfare, Helsinki, Finland
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Tanja Zeller
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Mahir Karakas
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany
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19
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Isn't it IRONic? In the era of complex cardiac procedures, the deficiency of a simple tiny cation makes a difference in acute coronary syndromes. Rev Port Cardiol 2021; 40:537-538. [PMID: 34392893 DOI: 10.1016/j.repce.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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20
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Peres M. Isn’t it IRONic? In the era of complex cardiac procedures, the deficiency of a simple tiny cation makes a difference in acute coronary syndromes. Rev Port Cardiol 2021. [DOI: 10.1016/j.repc.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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21
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Silva C, Martins J, Campos I, Arantes C, Braga CG, Salomé N, Gaspar A, Azevedo P, Álvares Pereira M, Marques J, Vieira C. Prognostic impact of iron deficiency in acute coronary syndromes. Rev Port Cardiol 2021; 40:525-536. [PMID: 34392892 DOI: 10.1016/j.repce.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/29/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with worse prognosis. Data in literature are scarce on the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study. METHODS Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n=298) or absence of IDef (n=519) on admission. The clinical event under study was the occurrence of death or severe HF in the long term. Independent predictors of prognosis were determined with logistic regression analysis. RESULTS Thirty-six percent of patients had IDef. There was higher mortality (p=0.004), higher incidence of HF (p=0.011) during follow-up and a higher rate of hospital readmissions (p=0.048) in this group. IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death. CONCLUSION IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.
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Affiliation(s)
- Carina Silva
- Serviço de Medicina Interna, Hospital Santa Maria Maior, Barcelos, Portugal
| | | | - Isabel Campos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Nuno Salomé
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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22
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Inserte J, Barrabés JA, Aluja D, Otaegui I, Bañeras J, Castellote L, Sánchez A, Rodríguez-Palomares JF, Pineda V, Miró-Casas E, Milà L, Lidón RM, Sambola A, Valente F, Rafecas A, Ruiz-Meana M, Rodríguez-Sinovas A, Benito B, Buera I, Delgado-Tomás S, Beneítez D, Ferreira-González I. Implications of Iron Deficiency in STEMI Patients and in a Murine Model of Myocardial Infarction. JACC Basic Transl Sci 2021; 6:567-580. [PMID: 34368505 PMCID: PMC8326269 DOI: 10.1016/j.jacbts.2021.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Abstract
In patients with STEMI treated with primary percutaneous coronary intervention, iron deficiency is associated with larger infarcts, more extensive microvascular obstruction, and a higher frequency of adverse left ventricular remodeling. An iron-deficient diet reduces the tolerance to ischemia/reperfusion in mice at least in part by interfering with the cardioprotective pathway eNOS/soluble guanylate cyclase/protein kinase G. An iron-deficient diet reduces eNOS activity by increasing oxidative/nitrosative stress and its proteasome-dependent degradation. Not only iron excess but also iron deficiency may have deleterious effects in the context of acute myocardial ischemia.
In patients with a first anterior ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention, iron deficiency (ID) was associated with larger infarcts, more extensive microvascular obstruction, and higher frequency of adverse left ventricular remodeling as assessed by cardiac magnetic resonance imaging. In mice, an ID diet reduced the activity of the endothelial nitric oxide synthase/soluble guanylate cyclase/protein kinase G pathway in association with oxidative/nitrosative stress and increased infarct size after transient coronary occlusion. Iron supplementation or administration of an sGC activator before ischemia prevented the effects of the ID diet in mice. Not only iron excess, but also ID, may have deleterious effects in the setting of ischemia and reperfusion.
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Key Words
- CK-MB, creatine kinase-myocardial band
- CMR, cardiac magnetic resonance
- HSP90, heat-shock protein 90
- ID, iron deficiency
- LV, left ventricular
- MVO, microvascular obstruction
- PKG, protein kinase G
- STEMI, ST-segment elevation acute myocardial infarction
- STIR, short tau inversion recovery
- VASP, vasodilator-stimulated phosphoprotein
- acute myocardial infarction
- eNOS, endothelial nitric oxide synthase
- endothelial nitric oxide synthase
- iNOS, inducible nitric oxide synthase
- iron deficiency
- myocardial reperfusion
- sGC, soluble guanylyl cyclase
- soluble guanylate cyclase
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Affiliation(s)
- Javier Inserte
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José A Barrabés
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - David Aluja
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Imanol Otaegui
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Jordi Bañeras
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Castellote
- Department of Biochemistry, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Ana Sánchez
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José F Rodríguez-Palomares
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Víctor Pineda
- Institut de Diagnòstic per la Imatge, Barcelona, Spain
| | - Elisabet Miró-Casas
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laia Milà
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Rosa-Maria Lidón
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonia Sambola
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Filipa Valente
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Agnès Rafecas
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Marisol Ruiz-Meana
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Antonio Rodríguez-Sinovas
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Begoña Benito
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Irene Buera
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Sara Delgado-Tomás
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - David Beneítez
- Department of Hematology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut d'Oncologia (VHIO), Barcelona, Spain
| | - Ignacio Ferreira-González
- Department of Cardiology, Vall d'Hebron Hospital Universitari and Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra, Spain.,Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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23
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Intravenous ferric carboxymaltose does not provide benefits in reperfused acute myocardial infarction in the rat with normal iron status. Biomed Pharmacother 2021; 141:111893. [PMID: 34243097 DOI: 10.1016/j.biopha.2021.111893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/02/2021] [Accepted: 06/28/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Iron deficiency has been implicated in the pathophysiology of heart failure and myocardial ischemia and reperfusion injury. Moreover, reperfused heart seems to lose iron, thus even subjects with normal iron status could benefit from iron therapy. Impaired mitochondrial respiration and energy starvation may be among possible consequences of myocardial iron deficiency. So far no attempts have been made to treat acute coronary syndromes with iron. Thus our aim was to verify the hypothesis that intravenous iron therapy given during reperfusion of an acute myocardial infarction will reduce left ventricular remodeling and hemodynamic abnormalities in a 2-month follow-up as well as early mitochondrial dysfunction and mortality, in the rat with normal iron status. METHODS AND RESULTS A single dose of ferric carboxymaltose was administered intravenously at 30 min of reperfusion following 30 min of ischemia in the rat model of myocardial infarction. Ventricular arrhythmias were monitored using a telemetric system, activity of mitochondrial enzymes was assessed using spectrophotometry, serum markers of oxidative stress and inflammation were determined and left ventricular function and remodeling were monitored using echocardiography and pressure-volume loops. Intravenous iron therapy did not affect post-myocardial infarction mortality, left ventricular size or function, ventricular arrhythmias, activity of mitochondrial respiratory chain, oxidative stress or markers of inflammation, but was not associated with any adverse effects. CONCLUSIONS Although ferric carboxymaltose given at reperfusion was safe, it was ineffective in this model of reperfused myocardial infarction in the rat with normal iron status.
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24
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Reply to commentary on the article entitled "Iron deficiency for prognosis in acute coronary syndrome - A systematic review and meta-analysis". Int J Cardiol 2021; 338:41. [PMID: 34062197 DOI: 10.1016/j.ijcard.2021.05.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/26/2021] [Indexed: 11/23/2022]
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25
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Silva C, Martins J, Campos I, Arantes C, Braga CG, Salomé N, Gaspar A, Azevedo P, Álvares Pereira M, Marques J, Vieira C. Prognostic impact of iron deficiency in acute coronary syndromes. Rev Port Cardiol 2021. [PMID: 34006413 DOI: 10.1016/j.repc.2020.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Iron deficiency (IDef) is a prevalent condition in patients with heart disease and in those with heart failure (HF). Evidence has shown that this deficit is associated with a worse prognosis. There is only a small amount of data in the literature regarding the prognostic impact of IDef in acute coronary syndromes (ACS), which is the main objective of this study. METHODS Observational, retrospective study which included 817 patients admitted for ACS. Two groups were defined according to the presence (n = 298) or absence of IDeF (n = 519) on admission. The clinical event under study was the occurrence of death or severe HF in long term. Independent predictors of prognosis were determined with logistic regression analysis. RESULTS 36% of patients had IDef. These patients had a higher mortality rate (p = 0.004), higher incidence of HF (p = 0.011) during follow-up and a higher rate of hospital readmissions (p = 0.048). IDef was an independent predictor of death or severe HF in follow-up, along with anemia, left ventricular dysfunction, renal dysfunction and the absence of revascularization. Besides, IDef also enabled us to further stratify the prognosis of patients without anemia based on the occurrence of death or severe HF and those with lower Killip classes (≤2) based on the occurrence of death. CONCLUSION IDef was an independent predictor of death or severe HF in patients admitted with ACS and enabled additional stratification for those without anemia on admission and in those with Killip classes ≤2.
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Affiliation(s)
- Carina Silva
- Serviço de Medicina Interna, Hospital Santa Maria Maior, Barcelos, Portugal
| | | | - Isabel Campos
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Carina Arantes
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Nuno Salomé
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - António Gaspar
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | - Pedro Azevedo
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
| | | | - Jorge Marques
- Serviço de Cardiologia, Hospital de Braga, Braga, Portugal
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26
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Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, Gebhard C. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J 2021; 41:1328-1336. [PMID: 31876924 DOI: 10.1093/eurheartj/ehz898] [Citation(s) in RCA: 154] [Impact Index Per Article: 51.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/01/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
Although health disparities in women presenting with acute coronary syndrome (ACS) have received growing attention in recent years, clinical outcomes from ACS are still worse for women than for men. Women continue to experience higher patient and system delays and receive less aggressive invasive treatment and pharmacotherapies. Gender- and sex-specific variables that contribute to ACS vulnerability remain largely unknown. Notwithstanding the sex differences in baseline coronary anatomy and function, women and men are treated the same based on guidelines that were established from experimental and clinical trial data over-representing the male population. Importantly, younger women have a particularly unfavourable prognosis and a plethora of unanswered questions remains in this younger population. The present review summarizes contemporary evidence for gender and sex differences in vascular biology, clinical presentation, and outcomes of ACS. We further discuss potential mechanisms and non-traditional risk conditions modulating the course of disease in women and men, such as unrecognized psychosocial factors, sex-specific vascular and neural stress responses, and the potential impact of epigenetic modifications.
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Affiliation(s)
- Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Judy Luu
- Division of Cardiology, Department of Internal Medicine, University of Manitoba, 820 Sherbrook Street, Winnipeg MB R3A, Manitoba, Canada
| | - Elena Osto
- Institute of Clinical Chemistry, University of Zurich and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Cardiology, University Heart Center, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Jolanta M Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.,Centre for Preclinical Research and Technology, Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Zwirki i Wigury 61, 02-091 Warsaw, Poland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland.,Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
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27
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Schäfer S, Aydin MA, Appelbaum S, Kuulasmaa K, Palosaari T, Ojeda F, Blankenberg S, Jousilahti P, Salomaa V, Karakas M. Low testosterone concentrations and prediction of future heart failure in men and in women: evidence from the large FINRISK97 study. ESC Heart Fail 2021; 8:2485-2491. [PMID: 33934533 PMCID: PMC8318459 DOI: 10.1002/ehf2.13384] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/18/2021] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
Aims The increased incidence of heart failure in men suggests that endogenous sex hormones might play a role in the development of heart failure, but epidemiological data remain sparse. Here, we evaluated the predictive value of low testosterone levels on future heart failure in the large population‐based FINRISK97 study. Methods and results Baseline serum testosterone concentrations were measured in 7855 subjects (3865 men and 3990 women) of the FINRISK97 study. During a median follow‐up (FU) of 13.8 years, a total of 564 heart failure events were recorded. The age‐adjusted baseline testosterone levels did not differ significantly between subjects developing incident heart failure during FU and those without incident events during FU (men: 16.6 vs. 17.1 nmol/L, P = 0.75; women: 1.15 vs. 1.17 nmol/L, P = 0.32). Relevant statistically significant correlations of testosterone levels were found with high‐density lipoprotein cholesterol levels (R = 0.22; P < 0.001), body mass index (R = −0.23; P < 0.001), and waist‐to‐hip ratio (R = −0.21; P < 0.001) in men, while statistically significant correlations in women were negligible in effect size. In sex‐stratified Cox regression analyses, taking age into account, a quite strong association between low testosterone and incident heart failure was found in men [hazard ratio (HR) 1.51 (95% confidence interval, CI: 1.09–2.10); P = 0.020 for lowest vs. highest quarter], but not in women [HR 0.70 (95% CI: 0.49–0.98); P = 0.086 for lowest vs. highest quarter]. Nevertheless, this association turned non‐significant after full adjustment including body mass index and waist‐to‐hip ratio, and testosterone levels were no longer predictive for incident heart failure—neither in men [HR 0.99 (95% CI: 0.70–1.42); P = 0.77 for lowest vs. highest quarter] nor in women [HR 0.92 (95% CI: 0.64–1.33); P = 0.99 for lowest vs. highest quarter]. Accordingly, Kaplan–Meier analyses did not reveal significant association of testosterone levels with heart failure. Conclusions Low levels of testosterone do not independently predict future heart failure.
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Affiliation(s)
- Sarina Schäfer
- Department for Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Muhammet Ali Aydin
- Department of Cardiology, St. Adolf-Stift Hospital Reinbek, Reinbek, Germany
| | - Sebastian Appelbaum
- Department for Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Kari Kuulasmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Francisco Ojeda
- Department for Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department for Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Veikko Salomaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mahir Karakas
- Department for Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Hamburg, Germany
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28
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Abstract
Abstract
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Affiliation(s)
- Tibor Kempf
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
| | - Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, Germany
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29
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Cases A, Puchades MJ, de Sequera P, Quiroga B, Martin-Rodriguez L, Gorriz JL, Portolés J. Iron replacement therapy in the management of anaemia in non-dialysis Chronic kidney disease patients: Perspective of the Spanish Nephrology Society Anaemia Group. Nefrologia 2021; 41:123-136. [PMID: 36166211 DOI: 10.1016/j.nefroe.2020.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/14/2020] [Indexed: 06/16/2023] Open
Abstract
This work presents an update on the management of iron deficiency in patients with chronic kidney disease (CKD), either with or without anaemia. A review is made of the recommendations of the guidelines for the treatment of iron deficiency in CKD. It also presents new studies on iron deficiency in patients with CKD, as well as new findings about iron therapy and its impact on clinical outcomes. Anaemia is a common complication of CRF, and is associated with a decrease in the quality of life of the patients, as well as an increase in morbidity and mortality. Iron deficiency (absolute or functional) is common in non-dialysis chronic kidney disease patients, and may cause anaemia or a low response to erythropoiesis-stimulating agents. For this reason, the clinical guidelines for the treatment of the anaemia in Nephrology indicate the correction of the deficiency in the presence of anaemia. Iron replacement therapy is indicated in patients with CKD and anaemia (Hb < 12 g/dl) in accordance with the guidelines. There is no unanimity in the indication of iron replacement therapy in patients with Hb > 12 g/dl, regardless of whether they have an absolute or functional iron deficiency. Intravenous iron replacement therapy is safe, more efficient and rapid than oral therapy for achieving an increase haemoglobin lels and reducing the dose of erythropoiesis-stimulating agents. For the administration of intravenous iron in non-dialysis chronic renal failure patients a strategy of high doses and low frequency would be preferred on being more convenient for the patient, preserves better the venous capital, and is safe and cost-effective. Iron plays an essential role in energy metabolism and other body functions beyond the synthesis of haemoglobin, for which the iron deficiency, even in the absence of anaemia, could have harmful effects in patients with CKD. The correction of the iron deficiency, in the absence of anaemia is associated with functional improvement in patients with heart failure, and in muscle function or fatigue in patients without CKD. Despite the evidence of benefits in the correction of iron deficiency in patients with CKD, more studies are required to evaluate the impact of the correction of the iron deficiency in the absence of anaemia on morbidity and mortality, quality of life and physical capacity, as well as the long-term effect of oral and intravenous iron replacement therapy in this population.
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Affiliation(s)
| | - Maria Jesús Puchades
- Servicio de Nefrología, Hospital Clínico, INCLIVA, Universidad de Valencia, Valencia, Spain
| | - Patricia de Sequera
- Servicio de Nefrología, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de la Princesa, Madrid, Servicio de Nefrología, Hospital Clínico, Valencia, INCLIVA, Universidad de Valencia, Spain
| | - Leyre Martin-Rodriguez
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, REDInREN ISCiii 016/009/009 RETYC, Majadahonda, Madrid, Spain
| | - José Luis Gorriz
- Servicio de Nefrología, Hospital Clínico, INCLIVA, Universidad de Valencia, Valencia, Spain.
| | - José Portolés
- Servicio de Nefrología, Hospital Universitario Puerta de Hierro Majadahonda, REDInREN ISCiii 016/009/009 RETYC, Majadahonda, Madrid, Spain
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30
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Reinhold J, Papadopoulou C, Baral R, Vassiliou VS. Iron deficiency for prognosis in acute coronary syndrome - A systematic review and meta-analysis. Int J Cardiol 2020; 328:46-54. [PMID: 33326805 DOI: 10.1016/j.ijcard.2020.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/23/2020] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Iron deficiency (ID) is an important predictor of adverse outcomes in patients with heart failure, however it is unclear whether ID also affects prognosis in patients with acute coronary syndrome (ACS). The aim of this systematic review and meta-analysis was to assess the prognostic value of iron deficiency in patients with ACS. METHODS We searched PubMed, Web of Science, and the Cochrane library and included cohort studies of patients with ACS that were stratified by ID status. There were no restrictions on definition of ACS or ID. Studies were systematically appraised and data extracted by two independent reviewers. Meta-analysis was performed where two or more studies reported on the same pre-determined outcome measure. RESULTS Seven studies with 2821 participants were identified, reporting a high prevalence of ID in the ACS population. Three studies reported worse long-term outcomes in the ID population, whereas short-term outcomes were heterogeneous across studies. CONCLUSIONS Patients with ID presenting with ACS may have a worse long-term prognosis but more studies are required for confirmation. A role for ID in prognosis of patients with ACS and as a potentially treatable condition may have implication for the current management of this patient population.
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Affiliation(s)
- Johannes Reinhold
- University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom.
| | - Charikleia Papadopoulou
- University of Cambridge, The Old Schools, Trinity Ln, Cambridge CB2 1TN, United Kingdom; Royal Papworth Hospital, Papworth Road, Cambridge Biomedical Campus, Cambridge CB2 0AY, United Kingdom
| | - Ranu Baral
- University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom
| | - Vassilios S Vassiliou
- University of East Anglia (UEA), Norwich Research Park, Norwich NR4 7TJ, United Kingdom; Norfolk and Norwich University Hospital, Colney Lane, Norwich NR4 7UY, United Kingdom
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Schrage B, Rübsamen N, Schulz A, Münzel T, Pfeiffer N, Wild PS, Beutel M, Schmidtmann I, Lott R, Blankenberg S, Zeller T, Lackner KJ, Karakas M. Iron deficiency is a common disorder in general population and independently predicts all-cause mortality: results from the Gutenberg Health Study. Clin Res Cardiol 2020; 109:1352-1357. [PMID: 32215702 DOI: 10.1007/s00392-020-01631-y/tables/3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/11/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND Iron deficiency is now accepted as an independent entity beyond anemia. Recently, a new functional definition of iron deficiency was proposed and proved strong efficacy in randomized cardiovascular clinical trials of intravenous iron supplementation. Here, we characterize the impact of iron deficiency on all-cause mortality in the non-anemic general population based on two distinct definitions. METHODS The Gutenberg Health Study is a population-based, prospective, single-center cohort study. The 5000 individuals between 35 and 74 years underwent baseline and a planned follow-up visit at year 5. Tested definitions of iron deficiency were (1) functional iron deficiency-ferritin levels below 100 µg/l, or ferritin levels between 100 and 299 µg/l and transferrin saturation below 20%, and (2) absolute iron deficiency-ferritin below 30 µg/l. RESULTS At baseline, a total of 54.5% of participants showed functional iron deficiency at a mean hemoglobin of 14.3 g/dl; while, the rate of absolute iron deficiency was 11.8%, at a mean hemoglobin level of 13.4 g/dl. At year 5, proportion of newly diagnosed subjects was 18.5% and 4.8%, respectively. Rate of all-cause mortality was 7.2% (n = 361); while, median follow-up was 10.1 years. After adjustment for hemoglobin and major cardiovascular risk factors, the hazard ratio with 95% confidence interval of the association of iron deficiency with mortality was 1.3 (1.0-1.6; p = 0.023) for the functional definition, and 1.9 (1.3-2.8; p = 0.002) for absolute iron deficiency. CONCLUSIONS Iron deficiency is very common in the apparently healthy general population and independently associated with all-cause mortality in the mid to long term.
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Affiliation(s)
- Benedikt Schrage
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Nicole Rübsamen
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Schulz
- Centre of Medicine II (Statistics), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
- Center for Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department for Opthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
- Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Rosemarie Lott
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Karl J Lackner
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.
- DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany.
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Weidmann H, Bannasch JH, Waldeyer C, Shrivastava A, Appelbaum S, Ojeda-Echevarria FM, Schnabel R, Lackner KJ, Blankenberg S, Zeller T, Karakas M. Iron Metabolism Contributes to Prognosis in Coronary Artery Disease: Prognostic Value of the Soluble Transferrin Receptor Within the AtheroGene Study. J Am Heart Assoc 2020; 9:e015480. [PMID: 32321351 PMCID: PMC7428563 DOI: 10.1161/jaha.119.015480] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Coronary heart disease is a leading cause of mortality worldwide. Iron deficiency, a frequent comorbidity of coronary heart disease, causes an increased expression of transferrin receptor and soluble transferrin receptor levels (sTfR) levels, while iron repletion returns sTfR levels to the normal physiological range. Recently, sTfR levels were proposed as a potential new marker of iron metabolism in cardiovascular diseases. Therefore, we aimed to evaluate the prognostic value of circulating sTfR levels in a large cohort of patients with coronary heart disease. Methods and Results The disease cohort comprised 3423 subjects who had angiographically documented coronary heart disease and who participated in the AtheroGene study. Serum levels of sTfR were determined at baseline using an automated immunoassay (Roche Cobas Integra 400). Two main outcomes were considered: a combined end point of myocardial infarction and cardiovascular death and cardiovascular death alone. During a median follow‐up of 4.0 years, 10.3% of the patients experienced an end point. In Cox regression analyses for sTfR levels, the hazard ratio (HR) for future cardiovascular death and/or myocardial infarction was 1.27 (95% CI, 1.11–1.44, P<0.001) after adjustment for sex and age. This association remained significant (HR, 1.23; 95% CI, 1.03–1.46, P=0.02) after additional adjustment for body mass index, smoking status, hypertension, diabetes mellitus, dyslipidemia, C‐reactive protein, and surrogates of cardiac function, size of myocardial necrosis (hs‐Tnl), and hemoglobin levels. Conclusions In this large cohort study, sTfR levels were strongly associated with future myocardial infarction and cardiovascular death. This implicates a role for sTfR in secondary cardiovascular risk prediction.
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Affiliation(s)
- Henri Weidmann
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Johannes H Bannasch
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany
| | - Christoph Waldeyer
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Apurva Shrivastava
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Sebastian Appelbaum
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany
| | | | - Renate Schnabel
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Karl J Lackner
- Department of Laboratory Medicine University Medical Center Johannes Gutenberg University Mainz Mainz Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main Mainz Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel Hamburg Germany
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Nikorowitsch J, Borchardt T, Appelbaum S, Ojeda F, Lackner KJ, Schnabel RB, Blankenberg S, Zeller T, Karakas M. Cardio-Renal Biomarker Soluble Urokinase-Type Plasminogen Activator Receptor Is Associated With Cardiovascular Death and Myocardial Infarction in Patients With Coronary Artery Disease Independent of Troponin, C-Reactive Protein, and Renal Function. J Am Heart Assoc 2020; 9:e015452. [PMID: 32299288 PMCID: PMC7428542 DOI: 10.1161/jaha.119.015452] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Risk stratification among patients with coronary artery disease (CAD) is of considerable interest due to the potential to guide secondary preventive therapies. Thus, we evaluated the predictive value of soluble urokinase-type plasminogen activator receptor (suPAR) levels for cardiovascular mortality and nonfatal myocardial infarction in patients with CAD. Methods and Results Plasma levels of suPAR were measured in a cohort of 1703 patients with documented CAD as evidenced by coronary angiography-including 626 patients with acute coronary syndrome and 1077 patients with stable angina pectoris. Cardiovascular death and/or nonfatal myocardial infarction were defined as main outcome measures. During a median follow-up of 3.5 years, suPAR levels reliably predicted cardiovascular death or myocardial infarction in CAD, evidenced by survival curves stratified for tertiles of suPAR levels. In Cox regression analyses, the hazard ratio for the prediction of cardiovascular death and/or myocardial infarction was 2.19 (P<0.001) in the overall cohort and 2.56 in the acute coronary syndrome cohort (P<0.001). Even after adjustment for common cardiovascular risk factors, renal function and the biomarkers C-reactive protein, N-terminal pro-B-type natriuretic peptide and high-sensitivity troponin I suPAR still enabled a reliable prediction of cardiovascular death or myocardial infarction with a hazard ratio of 1.61 (P=0.022) in the overall cohort and 2.22 (P=0.005) in the acute coronary syndrome cohort. Conclusions SuPAR has a strong and independent prognostic value in secondary prevention settings, and thereby might represent a valuable biomarker for risk estimation in CAD.
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Affiliation(s)
- Julius Nikorowitsch
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Tim Borchardt
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Sebastian Appelbaum
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Francisco Ojeda
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
| | - Karl J. Lackner
- Department of Laboratory MedicineUniversity Medical CenterJohannes Gutenberg University MainzMainzGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein‐MainMainzGermany
| | - Renate B. Schnabel
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, KielHamburgGermany
| | - Stefan Blankenberg
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, KielHamburgGermany
| | - Tanja Zeller
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, KielHamburgGermany
| | - Mahir Karakas
- Clinic of CardiologyUniversity Heart and Vascular Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, KielHamburgGermany
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Schrage B, Rübsamen N, Schulz A, Münzel T, Pfeiffer N, Wild PS, Beutel M, Schmidtmann I, Lott R, Blankenberg S, Zeller T, Lackner KJ, Karakas M. Iron deficiency is a common disorder in general population and independently predicts all-cause mortality: results from the Gutenberg Health Study. Clin Res Cardiol 2020; 109:1352-1357. [PMID: 32215702 PMCID: PMC7588396 DOI: 10.1007/s00392-020-01631-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/11/2020] [Indexed: 01/01/2023]
Abstract
Background Iron deficiency is now accepted as an independent entity beyond anemia. Recently, a new functional definition of iron deficiency was proposed and proved strong efficacy in randomized cardiovascular clinical trials of intravenous iron supplementation. Here, we characterize the impact of iron deficiency on all-cause mortality in the non-anemic general population based on two distinct definitions. Methods The Gutenberg Health Study is a population-based, prospective, single-center cohort study. The 5000 individuals between 35 and 74 years underwent baseline and a planned follow-up visit at year 5. Tested definitions of iron deficiency were (1) functional iron deficiency—ferritin levels below 100 µg/l, or ferritin levels between 100 and 299 µg/l and transferrin saturation below 20%, and (2) absolute iron deficiency—ferritin below 30 µg/l. Results At baseline, a total of 54.5% of participants showed functional iron deficiency at a mean hemoglobin of 14.3 g/dl; while, the rate of absolute iron deficiency was 11.8%, at a mean hemoglobin level of 13.4 g/dl. At year 5, proportion of newly diagnosed subjects was 18.5% and 4.8%, respectively. Rate of all-cause mortality was 7.2% (n = 361); while, median follow-up was 10.1 years. After adjustment for hemoglobin and major cardiovascular risk factors, the hazard ratio with 95% confidence interval of the association of iron deficiency with mortality was 1.3 (1.0–1.6; p = 0.023) for the functional definition, and 1.9 (1.3–2.8; p = 0.002) for absolute iron deficiency. Conclusions Iron deficiency is very common in the apparently healthy general population and independently associated with all-cause mortality in the mid to long term. Graphic abstract ![]()
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Affiliation(s)
- Benedikt Schrage
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Nicole Rübsamen
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Andreas Schulz
- Centre of Medicine II (Statistics), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Thomas Münzel
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.,Center for Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department for Opthalmology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Philipp S Wild
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.,Preventive Cardiology and Preventive Medicine, Center for Cardiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Center for Thrombosis and Hemostasis, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Irene Schmidtmann
- Institute for Medical Biometry, Epidemiology and Informatics, University Medical Center Mainz, Mainz, Germany
| | - Rosemarie Lott
- Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany
| | - Karl J Lackner
- DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Mainz, Germany.,Institute for Clinical Chemistry and Laboratory Medicine, University Medical Center Mainz, Mainz, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany. .,DZHK (German Center for Cardiovascular Research), Partner site, Hamburg/Kiel/Lübeck, Germany.
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35
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Iron deficiency in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Int J Cardiol 2020; 300:14-19. [DOI: 10.1016/j.ijcard.2019.07.083] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/18/2019] [Accepted: 07/28/2019] [Indexed: 12/11/2022]
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36
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Zeller T, Appelbaum S, Kuulasmaa K, Palosaari T, Blankenberg S, Jousilahti P, Salomaa V, Karakas M. Predictive value of low testosterone concentrations regarding coronary heart disease and mortality in men and women - evidence from the FINRISK97 study. J Intern Med 2019; 286:317-325. [PMID: 31121065 PMCID: PMC6851597 DOI: 10.1111/joim.12943] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The relevance of low testosterone concentrations for incident coronary heart disease (CHD) and mortality has been discussed in various studies. Here, we evaluate the predictive value of low baseline testosterone levels in a large population-based cohort. METHODS We measured the serum levels of testosterone in 7671 subjects (3710 male, 3961 female) of the population-based FINRISK97 study. RESULTS The median follow-up (FU) was 13.8 years. During the FU, a total of 779 deaths from any cause, and 395 incident CHD events were recorded. The age-adjusted baseline testosterone levels were similar in subjects suffering incident events during FU and those without incident events during FU (men: 15.80 vs. 17.01 nmol L-1 ; P = 0.69, women: 1.14 vs. 1.15 nmol L-1 ; P = 0.92). Weak correlations of testosterone levels were found with smoking (R = 0.09; P < 0.001), HDL cholesterol levels (R = 0.22, P < 0.001), systolic blood pressure (R = -0.05; P = 0.011), BMI (R = -0.23; P < 0.001) and waist-hip-ratio (R = -0.21; P < 0.001) in men, and with eGFR (R = -0.05; P = 0.009) in women. Kaplan-Meier analyses did not reveal a positive association of testosterone levels with incident CHD or mortality. Accordingly, also in Cox regression analyses, testosterone levels were not predictive for incident CHD or mortality - neither in men (HR 1.02 [95%CI: 0.70-1.51]; P = 0.79 for lowest versus highest quarter regarding CHD and HR 1.06 [95%CI: 0.80-1.39]; P = 0.67 regarding mortality), nor in women (HR 1.13 [95%CI: 0.69-1.85]; P = 0.56 for lowest versus highest quarter regarding CHD and HR 0.99 [95%CI: 0.71-1.39]; P = 0.80 regarding mortality). CONCLUSIONS Low levels of testosterone are not predictive regarding future CHD or mortality - neither in men, nor in women.
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Affiliation(s)
- T. Zeller
- Clinic of General and Interventional CardiologyUniversity Heart Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK)Partner Site HamburgLübeck, Kiel, HamburgGermany
| | - S. Appelbaum
- Clinic of General and Interventional CardiologyUniversity Heart Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK)Partner Site HamburgLübeck, Kiel, HamburgGermany
| | - K. Kuulasmaa
- National Institute for Health and WelfareHelsinkiFinland
| | - T. Palosaari
- National Institute for Health and WelfareHelsinkiFinland
| | - S. Blankenberg
- Clinic of General and Interventional CardiologyUniversity Heart Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK)Partner Site HamburgLübeck, Kiel, HamburgGermany
| | - P. Jousilahti
- National Institute for Health and WelfareHelsinkiFinland
| | - V. Salomaa
- National Institute for Health and WelfareHelsinkiFinland
| | - M. Karakas
- Clinic of General and Interventional CardiologyUniversity Heart Center HamburgHamburgGermany
- German Center for Cardiovascular Research (DZHK)Partner Site HamburgLübeck, Kiel, HamburgGermany
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37
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Diagnostic Value of Soluble Urokinase-Type Plasminogen Activator Receptor in Addition to High-Sensitivity Troponin I in Early Diagnosis of Acute Myocardial Infarction. Biomolecules 2019; 9:biom9030108. [PMID: 30889909 PMCID: PMC6468350 DOI: 10.3390/biom9030108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 03/08/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023] Open
Abstract
The soluble urokinase-type plasminogen activator receptor (suPAR) is a new marker for immune activation and inflammation and may provide diagnostic value on top of established biomarkers in patients with suspected acute myocardial infarction (AMI). Here, we evaluate the diagnostic potential of suPAR levels on top of high-sensitivity troponin I (hs-TnI) in a cohort of patients with suspected AMI. A total of 1220 patients presenting to the emergency department with suspected AMI were included, of whom 245 were diagnosed with AMI. Median suPAR levels at admission were elevated in subjects with AMI compared to non-AMI (3.8 ng/mL vs. 3.3 ng/mL, p = 0.001). In C-statistics, the area under the curve (AUC) regarding the diagnosis of AMI was low (0.57 at an optimized cut-off of 3.7 ng/mL). Moreover, baseline suPAR levels on top of troponin values at admission and hour 1 reduced the number of patients who were correctly ruled-out as non-AMI, and who were correctly ruled-in as AMI. Our study shows that circulating levels of suPAR on top of high-sensitivity troponin I do not improve the early diagnosis of AMI.
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Ruhe J, Waldeyer C, Ojeda F, Altay A, Schnabel RB, Schäfer S, Lackner KJ, Blankenberg S, Zeller T, Karakas M. Intrinsic Iron Release Is Associated with Lower Mortality in Patients with Stable Coronary Artery Disease-First Report on the Prospective Relevance of Intrinsic Iron Release. Biomolecules 2018; 8:biom8030072. [PMID: 30096922 PMCID: PMC6164542 DOI: 10.3390/biom8030072] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 08/03/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022] Open
Abstract
Intrinsic iron release is discussed to have favorable effects in coronary artery disease (CAD). The aim of this study was to evaluate the prognostic relevance of intrinsic iron release in patients with CAD. Intrinsic iron release was based on a definition including hepcidin and soluble transferrin receptor (sTfR). In a cohort of 811 patients with angiographically documented CAD levels of hepcidin and sTfR were measured at baseline. Systemic body iron release was defined as low levels of hepcidin (<24 ng/mL) and high levels of sTfR (≥2 mg/L). A commercially available ELISA (DRG) was used for measurements of serum hepcidin. Serum sTfR was determined by using an automated immunoassay (). Cardiovascular mortality was the main outcome measure. The criteria of intrinsic iron release were fulfilled in 32.6% of all patients. Significantly lower cardiovascular mortality rates were observed in CAD patients with systemic iron release. After adjustment for body mass index, smoking status, hypertension, diabetes, dyslipidemia, sex, and age, the hazard ratio for future cardiovascular death was 0.41. After an additional adjustment for surrogates of the size of myocardial necrosis (troponin I), anemia (hemoglobin), and cardiac function and heart failure severity (N-terminal pro B-type natriuretic peptide), this association did not change (Hazard ratio 0.37 (95% confidence interval 0.14⁻0.99), p = 0.047). In conclusion, significantly lower cardiovascular mortality rates were observed in CAD patients with intrinsic iron release shown during follow-up.
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Affiliation(s)
- Julia Ruhe
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
| | - Christoph Waldeyer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
| | - Francisco Ojeda
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
| | - Alev Altay
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, 20246 Hamburg, Germany.
| | - Sarina Schäfer
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, 20246 Hamburg, Germany.
| | - Karl J Lackner
- German Center for Cardiovascular Research (DZHK), Partner Site Rhein-Main, 55131 Mainz, Germany.
- Department of Laboratory Medicine, University Medical Center, Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, 20246 Hamburg, Germany.
| | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, 20246 Hamburg, Germany.
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, 20246 Hamburg, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg, Lübeck, Kiel, 20246 Hamburg, Germany.
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