Evaluation of Left Ventricular Hemodynamics with Noninvasive Methods in Cases of Iron Deficiency

Abstract

Objective: In this study, we aimed to evaluate the effect of iron deficiency on stress ejection fraction by assessing the change in left ventricular ejection fraction during maximum exercise in individuals with iron deficiency. Material and Methods: In this retrospective study, 212 patients, presenting with atypical chest pain and undergoing exercise gated myocardial perfusion scintigraphy, were included. Of the patients, 171 (80.7%) were female, with an average age of 50 (37-59) years. Patients were categorized into two groups: those with iron deficiency and those without. All patients exercised for a minimum of 6 minutes, reaching at least 85% of their maximum heart rate (220 - age). Hemogram, iron binding capacity, and serum ferritin values were recorded for all participants. In our study, SF less than 100 µg/L and TSAT less than 20% were considered low. Results: There was no significant difference in age and gender between the groups with and without iron deficiency (p: 0.758, p: 0.658). Echocardiography-calculated ejection fraction values were 66 (55-72). Rest ejection fraction obtained by force gated myocardial perfusion scintigraphy was 64 (52-70), and post-stress ejection fraction was calculated as 58 (50-69). The rate of decrease in post-stress EF compared to rest EF was calculated as 7.40% (7.81-19.12) in all patients. Echo, rest, and post-stress EF values in group 2 were significantly lower than those in group 1 (p: 0.003, 0.028, 0.0005, respectively). The rate of decrease in post-stress EF between the two groups was significantly higher in group 2 (p: 0.0005). Conclusion: While decreased iron stores and the presence of an iron deficiency state may be well-tolerated during daily activities, maximal exercise can exacerbate the condition if iron deficiency is underlying and undiagnosed. Early diagnosis of iron deficiency, common in society, before the onset of anemia, and prompt treatment are crucial for public health.