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Open Access Article

International Journal of Clinical Research. 2025; 9: (1) ; 72-77 ; DOI: 10.12208/j.ijcr.20250018.

Research progress on iron metabolism and heart failure
铁代谢与心力衰竭的研究进展

作者: 李仙琪1, 聂晨2, 熊玮1 *

1暨南大学第二临床医学院 广东深圳

2深圳市人民医院龙华分院 广东深圳

*通讯作者: 熊玮,单位:暨南大学第二临床医学院 广东深圳;

发布时间: 2025-01-15 总浏览量: 156

摘要

心力衰竭患者中铁缺乏较为常见,约占比50%。铁缺乏与心力衰竭患者的心衰再住院率、心血管事件发生率、心血管死亡率及全因死亡率显著相关。同时,心力衰竭患者因肠道水肿、摄入不足、药物相互作用等原因导致铁吸收、利用障碍,加重铁缺乏。目前欧洲及美国的指南均推荐射血分数减低心衰合并铁缺乏患者补充铁剂,以改善临床症状、运动耐量及生活质量。本文拟根据现有研究就心衰患者铁缺乏的病理生理、铁缺乏的临床诊断、治疗等进行综述。

关键词: 心力衰竭;铁剂治疗;铁缺乏

Abstract

Iron deficiency is relatively common in patients with heart failure, accounting for about 50%. Iron deficiency is significantly correlated with readmission rate, cardiovascular event incidence, cardiovascular mortality rate, and all-cause mortality rate in patients with heart failure. At the same time, patients with heart failure may experience iron absorption and utilization disorders due to intestinal edema, insufficient intake, and drug interactions, exacerbating iron deficiency. At present, guidelines in Europe and the United States recommend iron supplementation for patients with heart failure and iron deficiency who have reduced ejection fraction to improve clinical symptoms, exercise tolerance, and quality of life. This article intends to review the pathophysiology, clinical diagnosis, and treatment of iron deficiency in heart failure patients based on existing research.

Key words: Heart failure; Iron therapy; Iron deficiency

参考文献 References

[1] James S L, Abate D, Abate K H, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017[J]. The Lancet, 2018, 392(10159): 1789-1858.

[2] Savarese G, Becher P M, Lund L H, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology[J]. Cardiovascular Research, 2022, 118(17): 3272-3287. 

[3] Becher PM, Lund LH, Coats AJS, et al. An update on global epidemiology in heart failure [J]. Eur Heart J, 2022, 43 (32): 3005‐3007. 

[4] Cai A, Zheng C, Qiu J, et al. Prevalence of heart failure stages in the general population and implications for heart failure prevention: reports from the China Hypertension Survey 2012‐15 [J]. Eur J Prev Cardiol, 2023, 30 (13): 1391‐1400. 

[5] 张健,张宇辉,黄峻,等.国家心力衰竭指南2023. [J].中华心力衰竭和心肌病杂志,2023,38(12):1000-3614. 

[6] Andrews NC. Disorders of ironmetabolism [J]. N Engl J Med ,1999,341(26):1986–1995.

[7] YEO T J, YEO P S D, CHING‐CHIEW WONG R, et al. Iron deficiency in a multi‐ethnic Asian population with and without heart failure: prevalence, clinical correlates, functional significance and prognosis [J]. European Journal of Heart Failure, 2014, 16(10): 1125-32.

[8] VON HAEHLING S, GREMMLER U, KRUMM M, et al. Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry [J]. Clinical Research in Cardiology, 2017, 106(6): 436-443.

[9] JACOB C, ALTEVERS J, BARCK I, et al. Retrospective analysis into differences in heart failure patients with and without iron deficiency or anaemia [J]. ESC Heart Failure, 2019, 6(4): 840-55.

[10] KLIP I T, COMIN-COLET J, VOORS A A, et al. Iron deficiency in chronic heart failure: An international pooled analysis [J]. American Heart Journal, 2013, 165(4): 575-82.e3.

[11] VAN AELST L N L, ABRAHAM M, SADOUNE M, et al. Iron status and inflammatory biomarkers in patients with acutely decompensated heart failure: early in‐hospital phase and 30‐day follow‐up [J]. European Journal of Heart Failure, 2017, 19(8): 1075-1076.

[12] EMAMI A, VON HAEHLING S. Iron deficiency and risk of early readmission following a hospitalization for acute heart failure [J]. European Journal of Heart Failure, 2016, 18(7): 880.

[13] ALLAIN F, LOIZEAU V, CHAUFOURIER L, et al. Usefulness of a personalized algorithm‐based discharge checklist in patients hospitalized for acute heart failure [J]. ESC Heart Failure, 2020, 7(3): 1217-1223.

[14] HOWER V, MENDES P, TORTI F M, et al. A general map of iron metabolism and tissue-specific subnetworks [J]. Molecular BioSystems, 2009, 5(5):422-443.

[15] SAVARESE G, VON HAEHLING S, BUTLER J, et al. Iron deficiency and cardiovascular disease [J]. European Heart Journal, 2023, 44(1): 14-27.

[16] VIATTE L, VAULONT S. Hepcidin, the iron watcher [J]. Biochimie, 2009, 91(10): 1223-1228.

[17] Drexler H, Riede U, Münzel T, et al. Alterations of skeletal muscle in chronic heart failure[J]. Circulation 1992, 85(5): 1751–1759.

[18] GALY B, CONRAD M, MUCKENTHALER M. Mechanisms controlling cellular and systemic iron homeostasis [J]. Nature Reviews Molecular Cell Biology, 2023, 25(2): 133-155. 

[19] Koulaouzidis A, Said E, Cottier R, SaeedAA. Soluble transferrin receptors and iron deficiency, a step beyond ferritin.A systematic review [J]. Gastrointestin Liver Dis ,2009, 18(3): 345–352.

[20] Pasricha SR, Flecknoe-Brown SC, Allen KJ, et al.Diagnosis and management of iron defi-ciency anaemia: a clinical update[J]. Med J Aust 2010,194(8): 379–432.

[21] GROTE BEVERBORG N, KLIP I T, MEIJERS W C, et al. Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients [J]. Circulation: Heart Failure, 2018, 11(2):e004519.

[22] PHAM C G, BUBICI C, ZAZZERONI F, et al. Ferritin Heavy Chain Upregulation by NF-κB Inhibits TNFα-Induced Apoptosis by Suppressing Reactive Oxygen Species [J]. Cell, 2004, 119(4): 529-542. 

[23] SIERPINSKI R, JOSIAK K, SUCHOCKI T, et al. High soluble transferrin receptor in patients with heart failure: a measure of iron deficiency and a strong predictor of mortality [J]. European Journal of Heart Failure, 2020, 23(6): 919-932. 

[24] GRAHAM F J, PELLICORI P, KALRA P R, et al. Intravenous iron in patients with heart failure and iron deficiency: an updated meta‐analysis [J]. European Journal of Heart Failure, 2023, 25(4): 528-537. 

[25] KEMNA E H J M, TJALSMA H, WILLEMS H L, et al. Hepcidin: from discovery to differential diagnosis [J]. Haematologica, 2008, 93(1): 90-97.

[26] JANKOWSKA E A, MALYSZKO J, ARDEHALI H, et al. Iron status in patients with chronic heart failure [J]. European Heart Journal, 2012, 34(11): 827-834.

[27] PACKER M, ANKER S D, BUTLER J, et al. Redefining Iron Deficiency in Patients With Chronic Heart Failure [J]. Circulation, 2024, 150(2): 151-161. 

[28] JANKOWSKA E A, MALYSZKO J, ARDEHALI H, et al. Iron status in patients with chronic heart failure [J]. European Heart Journal, 2012, 34(11): 827-834.

[29] DOCHERTY K F, WELSH P, VERMA S, et al. Iron Deficiency in Heart Failure and Effect of Dapagliflozin: Findings From DAPA-HF [J]. Circulation, 2022, 146(13): 980-994.

[30] JANKOWSKA E A, KASZTURA M, SOKOLSKI M, et al. Iron deficiency defined as depleted iron stores accompanied by unmet cellular iron requirements identifies patients at the highest risk of death after an episode of acute heart failure [J]. European Heart Journal, 2014, 35(36): 2468-2476.

[31] AVNI T, BIEBER A, GROSSMAN A, et al. The Safety of Intravenous Iron Preparations [J]. Mayo Clinic Proceedings, 2015, 90(1): 12-23.

[32] OKONKO D O, GRZESLO A, WITKOWSKI T, et al. Effect of Intravenous Iron Sucrose on Exercise Tolerance in Anemic and Nonanemic Patients With Symptomatic Chronic Heart Failure and Iron Deficiency [J]. Journal of the American College of Cardiology, 2008, 51(2): 103-112.

[33] Anker SD, Comin Colet J, Filippatos G,et al.Ferric carboxymaltose in patients with heart failure and iron deficiency [J].N Engl J Med 2009,361(25):2436–2448. 

[34] MARTENS P, DUPONT M, DAUW J, et al. Rationale and design of the IRON‐CRT trial: effect of intravenous ferric carboxymaltose on reverse remodelling following cardiac resynchronization therapy [J]. ESC Heart Failure, 2019, 6(6): 1208-1215.

[35] KALRA P R, CLELAND J G F, PETRIE M C, et al. Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-endpoint trial [J]. The Lancet, 2022, 400(10369): 2199-2209. 

[36] Mentz RJ, Garg J, Rockhold FW, et al. HEART‑FID Investigators. Ferric carboxymaltose in heart failure with iron deficiency [J]. N Engl J Med, 2023, 389 (11): 975‑986.

[37] Ponikowski P, Kirwan BA, Anker SD, McDonagh T, et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial.[J].Lancet,2020,10266:1895-1904.

[38] METRA M, JANKOWSKA E A, PAGNESI M, et al. Impact of ischaemic aetiology on the efficacy of intravenous ferric carboxymaltose in patients with iron deficiency and acute heart failure: insights from the AFFIRM‐AHF trial [J]. European Journal of Heart Failure, 2022, 24(10): 1928-1939.

[39] KOMAJDA M, ANKER S D, CHARLESWORTH A, et al. The impact of new onset anaemia on morbidity and mortality in chronic heart failure: results from COMET [J]. European Heart Journal, 2006, 27(12): 1440-1446. 

[40] ISHANI A, WEINHANDL E, ZHAO Z, et al. Angiotensin-converting enzyme inhibitor as a risk factor for the development of anemia, and the impact of incident anemia on mortality in patients with left ventricular dysfunction [J]. Journal of the American College of Cardiology, 2005, 45(3): 391-399. 

[41] CURTAIN J P, ADAMSON C, DOCHERTY K F, et al. Prevalent and Incident Anemia in PARADIGM-HF and the Effect of Sacubitril/Valsartan [J]. JACC: Heart Failure, 2023, 11(7): 749-759. 

[42] DOCHERTY K F, CURTAIN J P, ANAND I S, et al. Effect of dapagliflozin on anaemia in DAPA‐HF [J]. European Journal of Heart Failure, 2021, 23(4): 617-628. 

[43] FUCHS ANDERSEN C, OMAR M, GLENTHøJ A, et al. Effects of empagliflozin on erythropoiesis in heart failure: data from the Empire HF trial [J]. European Journal of Heart Failure, 2022, 25(2): 226-234. 

[44] FU J, XU H, WU F, et al. Empagliflozin inhibits macrophage inflammation through AMPK signaling pathway and plays an anti-atherosclerosis role [J]. International Journal of Cardiology, 2022, 367: 56-62.

引用本文

李仙琪, 聂晨, 熊玮, 铁代谢与心力衰竭的研究进展[J]. 国际临床研究杂志, 2025; 9: (1) : 72-77.