title: Absolute iron deficiency without anaemia in patients with chronic systolic heart failure is associated with poorer functional capacity.
abstract: BACKGROUND
  Functional status is one of the main concerns in the management of heart failure (HF). Recently, the FAIR-HF and CONFIRM-HF trials showed that correcting anaemia using intravenous iron supplementation improved functional variables in patients with absolute or relative iron deficiency. Relative iron deficiency is supposed to be a marker of HF severity, as ferritin concentration increases with advanced stages of HF, but little is known about the impact of absolute iron deficiency (AID).
  
  
  OBJECTIVE
  To study the impact of AID on functional variables and survival in patients with chronic systolic HF.
  
  
  METHODS
  One hundred and thirty-eight non-anaemic patients with chronic systolic HF were included retrospectively. Patients were divided into two groups according to iron status: the AID group, defined by a ferritin concentration<100μg/L and the non-AID group, defined by a ferritin concentration≥100μg/L. Functional, morphological and biological variables were collected, and survival was assessed.
  
  
  RESULTS
  Patients in the AID group had a poorer 6-minute walking test (342 vs. 387m; P=0.03) and poorer peak exercise oxygen consumption (13.8 vs. 16.0mL/min/kg; P=0.01). By multivariable analysis, ferritin<100μg/L was associated with impaired capacity of effort, assessed by peak exercise oxygen consumption. By multivariable analysis, there was no difference in total mortality between groups, with a mean follow-up of 5.1±1.1 years.
  
  
  CONCLUSIONS
  The poorer functional evaluations in iron-deficient patients previously reported are not caused by the merging of two different populations (i.e. patients with absolute or relative iron deficiency). Our study has confirmed that non-anaemic HF patients with AID have poorer peak oxygen consumption. However, AID has no impact on the survival of these patients.
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Rangueil Medical School, Paul Sabatier University, Toulouse, France; Clinique Les Cèdres, Cornebarrieu, France.
authors.forename: Joffrey
authors.initials: J
authors.lastname: Pozzo
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Cardiac Imaging Centre, Toulouse University Hospital, France. Electronic address: Fournier.p@chu-toulouse.fr.
authors.forename: Pauline
authors.initials: P
authors.lastname: Fournier
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Rangueil Medical School, Paul Sabatier University, Toulouse, France.
authors.forename: Clément
authors.initials: C
authors.lastname: Delmas
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Rangueil Medical School, Paul Sabatier University, Toulouse, France.
authors.forename: Paul-Louis
authors.initials: PL
authors.lastname: Vervueren
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Purpan Medical School, Paul Sabatier University, Toulouse, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Roncalli
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Rangueil Medical School, Paul Sabatier University, Toulouse, France.
authors.forename: Meyer
authors.initials: M
authors.lastname: Elbaz
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Rangueil Medical School, Paul Sabatier University, Toulouse, France; Cardiac Imaging Centre, Toulouse University Hospital, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Galinier
authors.affiliation: Department of Cardiology, University Hospital of Rangueil, Toulouse, France; Rangueil Medical School, Paul Sabatier University, Toulouse, France; Cardiac Imaging Centre, Toulouse University Hospital, France; Purpan Medical School, Paul Sabatier University, Toulouse, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Lairez
mesh_terms: D018798:Anemia, Iron-Deficiency; D015415:Biomarkers / Q000097:blood; D019468:Disease Management; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D054143:Heart Failure, Systolic / Q000097:blood / Q000503:physiopathology*; D006801:Humans; D007501:Iron / Q000097:blood; D000090463:Iron Deficiencies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D015415:Biomarkers; D007501:Iron
keywords: Ferritinémie; Functional evaluation; Heart failure; Insuffisance cardiaque; Iron deficiency; Évaluation fonctionnelle