寻找慢性心力衰竭患者铁缺乏症的最佳标准。俄罗斯联邦慢性心力衰竭患者铁缺乏症患病率（ID-CHF-RF）"研究的事后分析。

IF 0.5 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Kardiologiya Pub Date : 2024-09-30 DOI:10.18087/cardio.2024.9.n2732

V Yu Mareev, Yu V Mareev, Zh D Kobalava, Yu L Begrambekova, L V Karapetyan, S A Galochkin, E R Kazakhmedov, A A Lapshin, A A Garganeeva, E A Kuzheleva, A A Efremushkina, E V Kiseleva, O L Barbarash, T B Pecherina, A S Galyavich, Z M Galeeva, L V Baleeva, N A Koziolova, A S Veclich, D V Duplyakov, M N Maksimova, S S Yakushin, E A Smirnova, E V Sedykh, I I Shaposhnik, N A Makarova, A A Zemlyanukhina, V V Skibitsky, A V Fendrikova, A V Skibitsky, N A Spiropoulos, E M Seredenina, Ya A Orlova, K A Eruslanova, Yu V Kotovskaya, O N Tkacheva, M A Fedin

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The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin <100 μg/l or ferritin from 100 to 299 μg/l and TSAT<20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT<19.8% or Fe ≤13 μmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 μmol/l criteria, and by both were analyzed.Results: ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 μmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 μmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 μmol/l vs. 19.4 μmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml).Conclusion: Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. 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引用次数: 0

摘要

目的：比较分析根据AHA/ESC/RSC标准诊断的慢性心力衰竭（CHF）和缺铁（ID）患者，以及根据转铁蛋白饱和度（TSAT）下降≤19.8%或血清铁（Fe）≤13 μmol/l诊断为ID的CHF患者的临床、病史、实验室和仪器数据：对 ID-CHF-RF 研究进行了补充分析。分析对象包括 498 名 CHF 患者（198 名女性）。除了方案规定的ID标准（AHA/ESC/RSC标准：铁蛋白<100 μg/l或铁蛋白从100到299 μg/l和TSAT<20%）外，还评估了ID生物标志物的浓度，与骨髓形态学图像（TSAT<19.8%或铁≤13 μmol/l）相比，ID诊断的敏感性和特异性都很高。分析了仅根据AHA/ESC/RSC标准、仅根据TSAT≤19.8%和铁≤13 μmol/l标准以及同时根据这两种标准确定的ID患者亚组：结果：83.1%的患者根据 AHA/ESC/RSC 标准诊断为 ID。TSAT≤19.8%和Fe≤13 μmol/l标准显示有74.5%的患者患有ID。有 341 名患者（76.8%）同时使用这两种标准诊断出 ID。与根据 AHA/ESC/RKO 标准诊断的 ID 患者相比，根据 TSAT≤19.8% 和 Fe≤13 μmol/l 标准诊断的 ID 患者的 Fe 值低 50%（9.8 μmol/l 对 19.4 μmol/l），贫血（43.3% 对 23.3%）和糖尿病（DM）（36.7% 和 24.7%）发生率更高。此外，这些患者的体重指数（BMI）和NT-proBNP浓度（2317 [1305;9092] vs. 1691 [709;3856] pg/ml）较高，左心室EF值（41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%）较低。根据两个标准确定的 ID 患者的 CHF 病程最严重，与 ID 和贫血相关的实验室检查变化最大。该组患者年龄较大，体重指数较高，心房颤动发生率较高，NT-proBNP（4182 [1854;9341] pg/ml）也较高：结论：与低 TSAT 或低铁蛋白患者相比，孤立性低铁蛋白患者的临床和功能损害程度较轻。同时，铁蛋白高于 300 μg/l 且 TSAT 和/或铁偏低的患者具有非常严重的慢性心力衰竭和功能低下的特征，尽管这可能与 ID 无关。因此，使用基于铁蛋白的 ID 标准可能会导致一些患者被过度诊断为 ID，同时也会漏诊一些可能需要进行 ID 矫正的最 "严重 "患者。三项指标均下降的 ID 患者可能从补充铁元素中获益最多。最好对补充铁元素对这部分患者的病程和预后的影响进行更多的研究。

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In Search of Optimal Criteria for Iron Deficiency in CHF Patients. Post-hoc Analysis of the Study "Prevalence of Iron Deficiency in Patients With Chronic Heart Failure in the Russian Federation (ID-CHF-RF)".

Aim: Comparative analysis of clinical, anamnestic, and laboratory and instrumental data of patients with chronic heart failure (CHF) and iron deficiency (ID) diagnosed according to the AHA/ESC/RSC criteria, and CHF patients diagnosed with ID based on decreased transferrin saturation (TSAT) ≤19.8% or serum iron (Fe) ≤13 μmol/l.

Material and methods: An additional analysis of the ID-CHF-RF study was performed. The analyzed population included 498 patients (198 women) with CHF. In addition to the ID criteria provided by the protocol (AHA/ESC/RSC criteria: ferritin <100 μg/l or ferritin from 100 to 299 μg/l and TSAT<20%), concentrations of ID biomarkers were assessed, which showed high sensitivity and specificity for the diagnosis of ID compared to the morphological picture of the bone marrow (TSAT<19.8% or Fe ≤13 μmol/l). Subgroups of patients with ID determined only by the AHA/ESC/RSC criteria, only by the TSAT≤19.8% and Fe ≤13 μmol/l criteria, and by both were analyzed.

Results: ID diagnosed by the AHA/ESC/RSC criteria was found in 83.1% of patients. The TSAT ≤19.8% and Fe ≤13 μmol/l criteria revealed ID in 74.5% of patients. In 341 patients (76.8%), ID was diagnosed using both criteria. Patients with ID diagnosed by the TSAT≤19.8% and Fe≤13 μmol/l criteria, compared with patients with ID diagnosed by the AHA/ESC/RKO criteria, had a 50% lower Fe (9.8 μmol/l vs. 19.4 μmol/l) and a higher incidence of anemia (43.3% vs. 23.3%) and diabetes mellitus (DM) (36.7% and 24.7%). Also, these patients had higher values of body mass index (BMI) and NT-proBNP concentration (2317 [1305;9092] vs. 1691 [709;3856] pg/ml), and lower LV EF values (41.5 [29.0;54.5]% vs. 45.0 [34.0;54.0]%), respectively. The most severe course of CHF and the greatest changes in laboratory tests associated with ID and anemia were observed in patients with ID determined by two criteria. Patients in this group were older, with a higher BMI, more frequent presence of atrial fibrillation, and higher NT-proBNP (4182 [1854;9341] pg/ml).

Conclusion: Patients with isolated low ferritin are characterized by less severe clinical and functional impairment compared to patients with low TSAT or Fe. At the same time, patients with ferritin higher than 300 μg/l and low TSAT and/or Fe were characterized by very severe CHF and a low functional status, although this may not be related with ID. Thus, the use of the ferritin-based criteria of ID may lead to overdiagnosis of ID in some patients and, at the same time, miss some of the most "severe" patients who likely require the ID correction. Patients with ID who show a decrease in all three parameters are likely to benefit most from Fe supplementation. It is advisable to perform additional studies on the effect of Fe supplements on the course and prognosis of the disease in this cohort of patients.

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来源期刊

Kardiologiya 医学-心血管系统

CiteScore

1.70

自引率

20.00%

发文量

审稿时长

3-8 weeks

期刊介绍： “Kardiologiya” (Cardiology) is a monthly scientific, peer-reviewed journal committed to both basic cardiovascular medicine and practical aspects of cardiology. As the leader in its field, “Kardiologiya” provides original coverage of recent progress in cardiovascular medicine. We publish state-of-the-art articles integrating clinical and research activities in the fields of basic cardiovascular science and clinical cardiology, with a focus on emerging issues in cardiovascular disease. Our target audience spans a diversity of health care professionals and medical researchers working in cardiovascular medicine and related fields. The principal language of the Journal is Russian, an additional language – English (title, authors’ information, abstract, keywords). “Kardiologiya” is a peer-reviewed scientific journal. All articles are reviewed by scientists, who gained high international prestige in cardiovascular science and clinical cardiology. The Journal is currently cited and indexed in major Abstracting & Indexing databases: Web of Science, Medline and Scopus. The Journal''s primary objectives Contribute to raising the professional level of medical researchers, physicians and academic teachers. Present the results of current research and clinical observations, explore the effectiveness of drug and non-drug treatments of heart disease, inform about new diagnostic techniques; discuss current trends and new advancements in clinical cardiology, contribute to continuing medical education, inform readers about results of Russian and international scientific forums; Further improve the general quality of reviewing and editing of manuscripts submitted for publication; Provide the widest possible dissemination of the published articles, among the global scientific community; Extend distribution and indexing of scientific publications in major Abstracting & Indexing databases.