title: The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure.
abstract: Anaemia and iron deficiency (ID) are important co-morbidities in patients with chronic heart failure (HF) and both may lead to reduced exercise capacity.
  
  
  METHODS
  We enrolled 331 out-patients with stable chronic HF (mean age: 64 ± 11 years, 17% female, left ventricular ejection fraction [LVEF] 35 ± 13%, body mass index [BMI] 28.5 ± 5.2 kg/m(2), New York Heart Association [NYHA] class 2.2 ± 0.7, chronic kidney disease 35%, glomerular filtration rate 61.7 ± 20.1 mL/min). Anaemia was defined according to World Health Organization criteria (haemoglobin [Hb] < 13 g/dL in men, < 12 g/dL in women). ID was defined as serum ferritin < 100 μg/L or ferritin < 300 μg/L with transferrin saturation (TSAT) < 20%. Exercise capacity was assessed as peak oxygen consumption (peak VO2) by spiroergometry and 6-minute walk test (6MWT).
  
  
  RESULTS
  A total of 91 (27%) patients died from any cause during a mean follow-up of 18 months. At baseline, 98 (30%) patients presented with anaemia and 149 (45%) patients presented with ID. We observed a significant reduction in exercise capacity in parallel to decreasing Hb levels (r = 0.24, p < 0.001). In patients with anaemia and ID (n = 63, 19%), exercise capacity was significantly lower than in patients with ID or anaemia only. Cox regression analysis showed that after adjusting for NYHA, age, hsCRP and creatinine anaemia is an independent predictor of mortality in patients with HF (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.33-0.97, p = 0.04).
  
  
  CONCLUSIONS
  The impact of anaemia on reduced exercise capacity and on mortality is stronger than that of ID. Anaemia remained an independent predictor of death after adjusting for clinically relevant variables.
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: Ebner
authors.affiliation: Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Poland.
authors.forename: Ewa A
authors.initials: EA
authors.lastname: Jankowska
authors.affiliation: Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Ponikowski
authors.affiliation: Department of Cardiology, General Hospital Celje, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Mitja
authors.initials: M
authors.lastname: Lainscak
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Elsner
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Veronika
authors.initials: V
authors.lastname: Sliziuk
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Lisa
authors.initials: L
authors.lastname: Steinbeck
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Kube
authors.affiliation: Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Tarek
authors.initials: T
authors.lastname: Bekfani
authors.affiliation: Center for Stroke Research Berlin, Charite University Medical School, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Scherbakov
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; 1st Department of Internal Medicine, Comenius University, Bratislava, Slovak Republic.
authors.forename: Miroslava
authors.initials: M
authors.lastname: Valentova
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Sandek
authors.affiliation: Center for Stroke Research Berlin, Charite University Medical School, Germany.
authors.forename: Wolfram
authors.initials: W
authors.lastname: Doehner
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Springer
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany.
authors.forename: Stefan D
authors.initials: SD
authors.lastname: Anker
authors.affiliation: Innovative Clinical Trials, Department of Cardiology and Pneumology, University of Medicine Göttingen, Germany; Applied Cachexia Research, Department of Cardiology, Charité-University Medical School, Campus Virchow-Klinikum Berlin, Germany. Electronic address: stephan.von.haehling@web.de.
authors.forename: Stephan
authors.initials: S
authors.lastname: von Haehling
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018798:Anemia, Iron-Deficiency / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D002908:Chronic Disease; D015331:Cohort Studies; D015897:Comorbidity; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Anaemia; Exercise capacity; Heart failure; Iron deficiency