https://doi.org/10.4081/cardio.2024.53
The association of iron deficiency with right ventricular dysfunction in Africans with heart failure
Published: December 30, 2024
Abstract Views: 207
PDF: 35
Appendix B: 62
Appendix A: 47
Appendix B: 62
Appendix A: 47
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Background: Iron deficiency (ID) is one of the common comorbidities in heart failure (HF) and is associated with poor morbidity and mortality, especially in Africans. It occurs along the full spectrum of HF phenotypes and is significantly related to left ventricular systolic function. Right ventricular dysfunction (RVD) is often associated with poorer prognosis and mortality. The association of ID and RVD in Africans with HF has not been well explored. We aimed to describe the relationship, if any between iron status and related parameters with right ventricular dysfunction in Africans with HF.
Methods: 140 subjects with HF were recruited consecutively from LAUTECH and Bowen Universities Teaching Hospitals, Ogbomoso, Nigeria. Full iron parameters were done for all participants. SPSS 25.0 was used for statistical analysis. ID was defined according to standardized criteria. RVD was determined using the tricuspid annular systolic pulmonary excursion (TAPSE) <20 mm. A p-value<0.05 was taken as statistically significant.
Results: The mean age of the study participants is 63.0±16.3 years. The mean body mass index was 24.7±6.5 kg/m2, while 42.9% were males. Anaemia was present in 106 (75.7%) of the study. RVD was present in 76 (54.3%) of the study participants, and it was commoner among those with ID (69.0%) compared to those with normal iron status (32.1%), p<0.001. Mean TAPSE was significantly lower among HF with ID compared with those without ID, 14.4±3.8 vs 16.6±4.52 mm, respectively; p<0.05. Pulmonary hypertension was commoner among HF with ID compared to those with normal iron parameters (33.3% vs 25.9%, respectively; p=0.048). In logistic regression analysis, serum ferritin, transferrin, and left atrial dimension were the major determinants of RVD in the study population.
Conclusions: ID is associated with RVD among Africans with HF. The prognostic implication and the potential reversibility of iron replacement therapy need further scrutiny. Identifying those with ID is congruent with increased risk of RVD in HF. Routine iron studies may be essential for future cardiovascular screening in Africans with heart failure and prevention of right ventricular dysfunction.
1. Akintunde AA. Right ventricular function in patients with heart failure in a cardiac clinic in Southwest Nigeria. Niger Med J 2017;58:7-12.
DOI: https://doi.org/10.4103/0300-1652.218411
2. Akintunde AA. The clinical value of the Tei index among Nigerians with hypertensive heart failure: Correlation with other conventional indices. Cardiovasc J Afr 2012;23:40-3.
DOI: https://doi.org/10.5830/CVJA-2011-032
3. Akintunde AA, Akinwusi PO, Familoni OB, Opadijo OG. Effect of systemic hypertension on right ventricular morphology and function: An echocardiographic study. Cardiovasc J Afr 2010;21:252-6.
DOI: https://doi.org/10.5830/CVJA-2010-013
4. Akinwusi PO, Okunola OO, Opadijo OG, et al. Hypertensive heart failure in Osogbo South-Western Nigeria: Clinical presentation and outcome. Niger Med Pract 2009;56:53-6.
5. Akintunde AA, Akinlade MO, Aworanti OW. Disordered iron homeostasis among Nigerians with chronic heart failure: pattern, prevalence, and clinical correlates. J Am Coll Cardiol 2021;10:17-25.
DOI: https://doi.org/10.4103/JCPC.JCPC_14_20
6. Akintunde AA, Akinlade OM, Egbewale BE, Opadijo OG. Iron deficiency anemia in Nigerians with heart failure (IDAN-HF): Therapeutic efficacy of iron replacement: An interventional study. Niger J Clin Pract 2021;24:21-7.
DOI: https://doi.org/10.4103/njcp.njcp_387_19
7. Maeder MT, Khammy O, dos Remedios C, Kaye DM. Myocardial and systemic iron depletion in heart failure implications for anaemia accompanying heart failure. J Am Coll Cardiol 2011; 58:474–480.
DOI: https://doi.org/10.1016/j.jacc.2011.01.059
8. Dong F, Zhang X, Culver B, et al. Dietary iron deficiency induces ventricular dilation, mitochondrial ultrastructural aberrations, and cytochrome c release: involvement of nitric oxide synthase and protein tyrosine nitration. Clin Sci (Lond) 2005;109:277-86.
DOI: https://doi.org/10.1042/CS20040278
9. Karaye KM, Sai'du H, Shehu MN. Right ventricular dysfunction in a hypertensive population stratified by patterns of left ventricular geometry. Cardiovasc J Afr 2012;23:478-82.
DOI: https://doi.org/10.5830/CVJA-2012-014
10. Bogaard HJ, Abe K, Vonk Noordegraaf A, Voelkel NF. The right ventricle under pressure: Cellular and molecular mechanisms of right-heart failure in pulmonary hypertension. Chest 2009;135:794-804.
DOI: https://doi.org/10.1378/chest.08-0492
11. Rako ZA, Kremer N, Yogeswaran A, et al. Adaptive versus maladaptive right ventricular remodelling. ESC Heart Fail 2023;10:762-75.
DOI: https://doi.org/10.1002/ehf2.14233
12. Oketona OA, Balogun MO, Akintomide AO, et al. Right ventricular systolic function in hypertensive heart failure. Vasc Health Risk Manag 2017;13:353-60.
DOI: https://doi.org/10.2147/VHRM.S142429
13. McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-726.
DOI: https://doi.org/10.1093/eurheartj/ehab368
14. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). J Am Soc Echocardiogr 2003;16:1091-110.
DOI: https://doi.org/10.1016/S0894-7317(03)00685-0
15. Aloia E, Cameli M, D'Ascenzi F, et al. TAPSE: An old but useful tool in different diseases. Int J Cardiol 2016;225:177-83.
DOI: https://doi.org/10.1016/j.ijcard.2016.10.009
16. Tkaczyszyn M, Comín-Colet J, Voors AA, et al. Iron deficiency and red cell indices in patients with heart failure. Eur J Heart Fail 2018;20:114-22.
DOI: https://doi.org/10.1002/ejhf.820
17. Chopra VK, Anker SD. Anaemia, iron deficiency and heart failure in 2020: facts and numbers. ESC Heart Fail 2020;7:2007-11.
DOI: https://doi.org/10.1002/ehf2.12797
18. Miñana G, Santas E, de la Espriella R, et al. Right ventricular function and iron deficiency in acute heart failure. Eur Heart J Acute Cardiovasc Care 2021;10:406-14.
DOI: https://doi.org/10.1093/ehjacc/zuaa028
19. Yu J, Yu L, Li Y, Hu F. Iron deficiency is a possible risk factor causing right heart failure in Tibetan children living in high altitude area. Medicine (Baltimore) 2020;99:e21133.
DOI: https://doi.org/10.1097/MD.0000000000021133
20. Amaechi UM, Chukwudum E, Aiwuyo HO, et al. Clinical and echocardiographic correlates of iron status in chronic heart failure patients: a cross-sectional descriptive study. Cureus 2023;15:e39998.
DOI: https://doi.org/10.7759/cureus.39998
21. Makubi A, Lwakatare J, Ogah OS, et al. Anaemia and iron deficiency in heart failure: epidemiological gaps, diagnostic challenges and therapeutic barriers in sub-Saharan Africa. Cardiovasc J Afr 2017;28:331-7.
DOI: https://doi.org/10.5830/CVJA-2017-001
22. Makubi A, Roberts DJ. Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower- and Middle-Income Countries. Br J Haematol 2017;177:896-904.
DOI: https://doi.org/10.1111/bjh.14650
23. Zhang H, Jamieson KL, Grenier J, et al. Myocardial iron deficiency and mitochondrial dysfunction in advanced heart failure in humans. J Am Heart Assoc 2022;11:e022853.
DOI: https://doi.org/10.1161/JAHA.121.022853
24. Mousavi-Aghdas SA, Farashi E, Naderi N. Iron dyshomeostasis and mitochondrial function in the failing heart: a review of the literature. Am J Cardiovasc Drugs 2024;24:19-37.
DOI: https://doi.org/10.1007/s40256-023-00619-z
25. Brown DA, Perry JB, Allen ME, et al. Mitochondrial function as a therapeutic target in heart failure. Nat Rev Cardiol 2017;14:238-50.
DOI: https://doi.org/10.1038/nrcardio.2016.203
26. Nickel A, Löffler J, Maack C. Myocardial energetics in heart failure. Basic Res Cardiol 2013;108:358.
DOI: https://doi.org/10.1007/s00395-013-0358-9
27. Engin K, Sinan UY, Arslan S, Kucukoglu MS. The effect of iron deficiency on RV function in acute decompensated heart failure patients. Eur Heart J 2023;44:ehad655.929.
DOI: https://doi.org/10.1093/eurheartj/ehad655.929
28. van der Wal HH, Grote Beverborg N, Dickstein K, et al. Iron deficiency in worsening heart failure is associated with reduced estimated protein intake, fluid retention, inflammation, and antiplatelet use. Eur Heart J 2019;40:3616-25.
DOI: https://doi.org/10.1093/eurheartj/ehz680
29. Ohno Y, Hanawa H, Jiao S, et al. Liver congestion in heart failure contributes to inappropriately increased serum hepcidin despite anemia. Tohoku J Exp Med 2015;235:69-79.
DOI: https://doi.org/10.1620/tjem.235.69
30. Grote Beverborg N, van der Wal HH, Klip IT, et al. Differences in clinical profile and outcomes of low iron storages vs defective iron utilization in patients with heart failure. JAMA Cardiol 2019;4:696-701.
DOI: https://doi.org/10.1001/jamacardio.2019.1739
31. Nemeth E, Valore EV, Territo M, et al. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein. Blood 2003;101:2461-3.
DOI: https://doi.org/10.1182/blood-2002-10-3235
32. Ganz T. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood 2003;102:783-8.
DOI: https://doi.org/10.1182/blood-2003-03-0672
33. Rhodes CJ, Howard LS, Busbridge M, et al. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension: clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol 2011;58:300-309.
DOI: https://doi.org/10.1016/j.jacc.2011.02.057
34. Anker SD, Kirwan B-A, van Veldhuisen DJ, et al. Effects of ferric carboxymaltose on hospitalizations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail 2018;20:125-33.
DOI: https://doi.org/10.1002/ejhf.823
How to Cite
Akintunde, A. A., & Orugun, S. T. (2024). The association of iron deficiency with right ventricular dysfunction in Africans with heart failure. Global Cardiology, 2(4). https://doi.org/10.4081/cardio.2024.53
Copyright (c) 2024 the Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Maryanne Caruana, Philip Moons, Adrienne H. Kovacs, Koen Luyckx, Corina Thomet, Werner Budts, Maayke Sluman, Katrine Eriksen, Mikael Dellborg, Malin Berghammer, Bengt Johansson, Alexandra Soufi, Edward Callus, Victor Grech, Silke Apers, Quality of life in Maltese adults with congenital heart disease: a second look , Global Cardiology: Vol. 2 No. 1 (2024)
- Reinaldo B. Bestetti, Rosemary Furlan-Daniel, Luciano P. Pereira, COVID-19 myocarditis , Global Cardiology: Vol. 2 No. 1 (2024)
- Prithwish Banerjee, Elevated left ventricular end diastolic pressure, chronic pulmonary oedema and valve disease , Global Cardiology: Vol. 2 No. 1 (2024)
- Tariq Jamal Siddiqi, Javed Butler, Andrew J.S. Coats, Subodh Verma, Tim Friede, Gerasimos Filippatos, Stefan D. Anker, SGLT2 inhibitors and risk reduction for mortality in high-risk patients: a meta-analysis of randomized controlled trials , Global Cardiology: Vol. 1 No. 1 (2023)
- Ralph Stephan von Bardeleben, Muhammad Shahzeb Khan, Martin Geyer, Tim Friede, Javed Butler, Monika Diek, Jutta Heinrich, Marius Placzek, Roberto Ferrari, William T. Abraham, Ottavio Alfieri, Angelo Auricchio, Antoni Bayes-Genis, John G.F. Cleland, Gerasimos Filippatos, Finn Gustafsson, Wilhelm Haverkamp, Malte Kelm, Karl-Heinz Kuck, Ulf Landmesser, Aldo P. Maggioni, Marco Metra, Vlasis Ninios, Mark C. Petrie, Tienush Rassaf, Frank Ruschitzka, Ulrich Schäfer, P. Christian Schulze, Konstantinos Spargias, Alec Vahanian, Jose Luis Zamorano, Andreas Zeiher, Mahir Karakas, Friedrich Koehler, Mitja Lainscak, Alper Öner, Nikolaos Mezilis, Efstratios K. Theofilogiannakos, Ilias Ninios, Michael Chrissoheris, Panagiota Kourkoveli, Konstantinos Papadopoulos, Grzegorz Smolka, Wojciech Wojakowski, Krzysztof Reczuch, Fausto J. Pinto, Łukasz Wiewiórka, Zbigniew Kalarus, Marianna Adamo, Evelyn Santiago-Vacas, Tobias Friedrich Ruf, Michael Gross, Joern Tongers, Gerd Hasenfuß, Wolfgang Schillinger, Piotr Ponikowski, Stefan D. Anker, Baseline echocardiographic characteristics of patients enrolled in the randomized investigation of MitraClip device in heart failure (RESHAPE HF-2) trial: comparison with COAPT and Mitra-FR , Global Cardiology: Vol. 2 No. 2 (2024)
- Sven Christopher Aland, Christoph Gertler, Hannah Leonie Bräunig, Timo Schröder, Frank Edelmann, Rolf Wachter, Christoph Herrmann-Lingen, Gerd Hasenfuß, Anja Sandek, Exercise capacity, iron deficiency and depressive symptoms in patients with asymptomatic chronic systolic heart failure , Global Cardiology: Vol. 2 No. 2 (2024)
- Muhammad Shahzeb Khan, Javed Butler, Laibah Arshad Khan, Markus S. Anker, Advanced cancer as a heart failure like syndrome due to cardiac wasting cardiomyopathy: facts and numbers , Global Cardiology: Vol. 2 No. 4 (2024)
- Camila Bedo, Juan C. Grignola, Preferential vasodilator effects of levosimendan in resistance pulmonary arteries in a rodent pulmonary embolism model , Global Cardiology: Vol. 2 No. 1 (2024)
- Kamilu M. Karaye, Idris Y. Mohammed, Hadiza Sa’idu, Naser A. Ishaq, Suleiman A. Balarabe, Jamilu Tukur, Tewogbade A. Adedeji, Olufemiwa N. Makinde, Rasaaq A. Adebayo, Prevalence of left ventricular dysfunction and relationship with serum selenium in apparently healthy pregnant women: results from the PEACE registry , Global Cardiology: Vol. 2 No. 2 (2024)
- Rachel Anne Xuereb, Sara Xuereb, Kentaro Yamagata, Robert George Xuereb, Anomalous origin of right coronary artery from the pulmonary artery: an incidental finding on cardiac computed tomography in a patient presenting with dyspnea , Global Cardiology: Vol. 2 No. 1 (2024)
You may also start an advanced similarity search for this article.
