Iron metabolism in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension
- 作者: Zhilenkova Y.I.1, Zolotova E.A.1, Vasilyeva E.Y.1, Simakova M.A.1, Karelkina E.V.1, Goncharova N.S.1, Moiseeva O.M.1, Vavilova T.V.1
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隶属关系:
- Almazov National Medical Research Centre
- 期: 卷 69, 编号 6 (2024)
- 页面: 30-43
- 栏目: Original Study Articles
- ##submission.datePublished##: 25.05.2024
- URL: https://kld-journal.fedlab.ru/0869-2084/article/view/629834
- DOI: https://doi.org/10.17816/cld629834
- ID: 629834
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BACKGROUND: Many patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension experience iron deficiency, which is associated with decreased exercise capacity and higher mortality.
AIM: To examine iron metabolism and the prevalence of iron deficiency in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension based on various laboratory criteria.
MATERIALS AND METHODS: The study included 20 patients with pulmonary arterial hypertension and 51 with chronic thromboembolic pulmonary hypertension. All patients underwent blood tests, C-reactive protein, NT-proBNP, and iron metabolism indicators, namely, serum iron, transferrin, serum ferritin, and soluble transferrin receptors. Transferrin saturation and soluble transferrin receptors to the logarithm of ferritin ratio were calculated.
RESULTS: The prevalence of iron deficiency based on various criteria was higher in the pulmonary arterial hypertension group. In the chronic thromboembolic pulmonary hypertension group, the following differences were observed: female patients had higher serum ferritin levels (p=0.04) and transferrin saturation (p=0.024), whereas serum ferritin levels were higher in both groups (p <0.001) and among women (p=0.001). The levels of soluble transferrin receptors to the logarithm of ferritin ratio in the chronic thromboembolic pulmonary hypertension group were lower (p=0.018); however, when compared with the female subgroup, the differences disappeared. In the pulmonary arterial hypertension group, serum ferritin level of <30 μg/L and transferrin saturation <20% helped identify 70–75% of patients with iron deficiency. In the chronic thromboembolic pulmonary hypertension group, in which aseptic inflammation plays a major role in its pathogenesis, only the use of parameters such as soluble transferrin receptors to the logarithm of ferritin ratio of >2 and transferrin saturation of <20% allowed identifying a comparable number of patients with iron deficiency (50–53%).
CONCLUSION: The results of the study of iron metabolism indicate that pathogenetic variants of iron deficiency vary among patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. In the pulmonary arterial hypertension group, absolute iron deficiency is much more common, whereas in the chronic thromboembolic pulmonary hypertension group, inflammation probably makes a more significant contribution, which in most cases leads to the development of functional iron deficiency and requires the use of diagnostic criteria recommended for patients with chronic diseases.
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作者简介
Yulia Zhilenkova
Almazov National Medical Research Centre
编辑信件的主要联系方式.
Email: yuliaismailovna@mail.ru
ORCID iD: 0000-0003-2756-0334
SPIN 代码: 4602-5081
MD, Cand. Sci. (Medicine)
俄罗斯联邦, Saint PetersburgEkaterina Zolotova
Almazov National Medical Research Centre
Email: katerinazolotova1@gmail.com
ORCID iD: 0000-0001-7399-2811
SPIN 代码: 5606-0750
俄罗斯联邦, Saint Petersburg
Elena Vasilyeva
Almazov National Medical Research Centre
Email: elena-almazlab@yandex.ru
ORCID iD: 0000-0002-2115-8873
SPIN 代码: 8546-5546
MD, Cand. Sci. (Medicine)
俄罗斯联邦, Saint PetersburgMaria Simakova
Almazov National Medical Research Centre
Email: maria.simakova@gmail.com
ORCID iD: 0000-0001-9478-1941
SPIN 代码: 3841-6593
MD, Cand. Sci. (Medicine)
俄罗斯联邦, Saint PetersburgElena Karelkina
Almazov National Medical Research Centre
Email: ekarelkina@mail.ru
ORCID iD: 0000-0002-3655-9709
SPIN 代码: 7454-5322
俄罗斯联邦, Saint Petersburg
Natalia Goncharova
Almazov National Medical Research Centre
Email: ns.goncharova@gmail.com
ORCID iD: 0000-0001-6954-7096
SPIN 代码: 1713-8825
MD, Cand. Sci. (Medicine)
俄罗斯联邦, Saint PetersburgOlga Moiseeva
Almazov National Medical Research Centre
Email: moiseeva.cardio@gmail.com
ORCID iD: 0000-0002-7817-3847
SPIN 代码: 1492-3900
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, Saint PetersburgTatiana Vavilova
Almazov National Medical Research Centre
Email: vtv.lab.spb@mail.ru
ORCID iD: 0000-0001-8537-3639
SPIN 代码: 9003-6455
MD, Dr. Sci. (Medicine), Professor
俄罗斯联邦, Saint Petersburg参考
- Cappellini MD, Comin-Colet J, De Francisco A, et al. Iron deficiency across chronic inflammatory conditions: International expert opinion on definition, diagnosis, and management. American journal of hematology. 2017;92(10):1068–1078. doi: 10.1002/ajh.24820
- Anand IS, Gupta P. Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies. Circulation. 2018;138(1):80–98. doi: 10.1161/CIRCULATIONAHA.118.030099
- Melenovsky V, Petrak J, Mracek T, et al. Myocardial iron content and mitochondrial function in human heart failure: a direct tissue analysis. European journal of heart failure. 2017;19(4):522–530. doi: 10.1002/ejhf.640
- Jankowska EA, Rozentryt P, Witkowska A, et al. Iron Deficiency Predicts Impaired Exercise Capacity in Patients With Systolic Chronic Heart Failure. Journal of cardiac failure. 2011;17(11):899–906. doi: 10.1016/j.cardfail.2011.08.003
- Klip IT, Comin-Colet J, Voors AA, et al. Iron deficiency in chronic heart failure: An international pooled analysis. American heart journal. 2013;165(4):575–582.e3. doi: 10.1016/j.ahj.2013.01.017
- Yeo TJ, Yeo PSD, 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. European journal of heart failure. 2014;16(10):1125–1132. doi: 10.1002/ejhf.161
- Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European heart journal. 2016;37(27):2129–2200. doi: 10.1093/eurheartj/ehw128
- Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. European respiratory journal. 2019;53(1):1801913. doi: 10.1183/13993003.01913-2018
- Sonnweber T, Pizzini A, Tancevski I, Löffler-Ragg J, Weiss G. Anaemia, iron homeostasis and pulmonary hypertension: a review. Internal and emergency medicine. 2020;15(4):573–585. doi: 10.1007/s11739-020-02288-1
- Rhodes CJ, Howard LS, Busbridge M, et al. Iron Deficiency and Raised Hepcidin in Idiopathic Pulmonary Arterial Hypertension. Journal of the American College of Cardiology. 2011;58(3):300–309. doi: 10.1016/j.jacc.2011.02.057
- Vinke P, Koudstaal T, Muskens F, et al. Prevalence of Micronutrient Deficiencies and Relationship with Clinical and Patient-Related Outcomes in Pulmonary Hypertension Types I and IV. Nutrients. 2021;13(11):3923. doi: 10.3390/nu13113923
- Grote Beverborg N, van Veldhuisen DJ, van der Meer P. Anemia in Heart Failure: Still Relevant. JACC: Heart Failure. 2018;6(3):201–208. doi: 10.1016/j.jchf.2017.08.023
- Nemeth E, Ganz T. Hepcidin-Ferroportin Interaction Controls Systemic Iron Homeostasis. IJMS. 2021;22(12):6493. doi: 10.3390/ijms22126493
- Rana S, Prabhakar N. Iron disorders and hepcidin. Clinica Chimica Acta. 2021;523:454–468. doi: 10.1016/j.cca.2021.10.032
- Sonnweber T, Nairz M, Theurl I, et al. The crucial impact of iron deficiency definition for the course of precapillary pulmonary hypertension. PLoS ONE. 2018;13(8):e0203396. doi: 10.1371/journal.pone.0203396
- Quatredeniers M, Mendes-Ferreira P, Santos-Ribeiro D, et al. Iron Deficiency in Pulmonary Arterial Hypertension: A Deep Dive into the Mechanisms. Cells. 2021;10(2):477. doi: 10.3390/cells10020477
- Infusino I, Braga F, Dolci A, Panteghini M. Soluble Transferrin Receptor (sTfR) and sTfR/log Ferritin Index for the Diagnosis of Iron-Deficiency Anemia. A Meta-Analysis. American journal of clinical pathology. 2012;138(5):642–629. doi: 10.1309/AJCP16NTXZLZFAIB
- Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. European heart journal. 2022;43(38):3618–3731. doi: 10.1183/13993003.00879-2022
- Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting Survival in Pulmonary Arterial Hypertension: Insights From the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. 2010;122(2):164–172. doi: 10.1161/CIRCULATIONAHA.109.898122
- Hurdman J, Condliffe R, Elliot CA, et al. ASPIRE registry: Assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre. European respiratory journal. 2012;39(4):945–955. doi: 10.1183/09031936.00078411
- Cappellini MD, Musallam KM, Taher AT. Iron deficiency anaemia revisited. Journal of internal medicine. 2020;287(2):153–170. doi: 10.1111/joim.13004
- Grote Beverborg N, Klip IjT, Meijers WC, et al. Definition of Iron Deficiency Based on the Gold Standard of Bone Marrow Iron Staining in Heart Failure Patients. Circ: Heart Failure. 2018;11(2):e004519. doi: 10.1161/CIRCHEARTFAILURE.117.004519
- Sandqvist A, Kylhammar D, Bartfay SE, et al. Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival. Scandinavian cardiovascular journal. 2021;55(1):43–49. doi: 10.1080/14017431.2020.1783456
- Ruiter G, Manders E, Happé CM, et al. Intravenous Iron Therapy in Patients with Idiopathic Pulmonary Arterial Hypertension and Iron Deficiency. Pulm Circulation. 2015;5(3):466–472. doi: 10.1086/682217
- Viethen T, Gerhardt F, Dumitrescu D, et al. Ferric carboxymaltose improves exercise capacity and quality of life in patients with pulmonary arterial hypertension and iron deficiency: A pilot study. International journal of cardiology. 2014;175(2):233–239. doi: 10.1016/j.ijcard.2014.04.233
- Lopez A, Cacoub P, Macdougall IC, Peyrin-Biroulet L. Iron deficiency anaemia. Lancet. 2016;387(10021):907–916. doi: 10.1016/S0140-6736(15)60865-0
- Quarck R, Wynants M, Verbeken E, Meyns B, Delcroix M. Contribution of inflammation and impaired angiogenesis to the pathobiology of chronic thromboembolic pulmonary hypertension. European respiratory journal. 2015;46(2):431–443. doi: 10.1183/09031936.00009914
- Zabini D, Heinemann A, Foris V, et al. Comprehensive analysis of inflammatory markers in chronic thromboembolic pulmonary hypertension patients. European respiratory journal. 2014;44(4):951–962. doi: 10.1183/09031936.00145013
- Mirza FG, Abdul-Kadir R, Breymann C, Fraser IS, Taher A. Impact and management of iron deficiency and iron deficiency anemia in women’s health. Expert review of hematology. 2018;11(9):727–736. doi: 10.1080/17474086.2018.1502081
- Muñoz M, Acheson AG, Bisbe E, et al. An international consensus statement on the management of postoperative anaemia after major surgical procedures. Anaesthesia. 2018;73(11):1418–1431. doi: 10.1111/anae.14358
- Peyrin-Biroulet L, Williet N, Cacoub P. Guidelines on the diagnosis and treatment of iron deficiency across indications: a systematic review. The American journal of clinical nutrition. 2015;102(6):1585–1594. doi: 10.3945/ajcn.114.103366
- Kernan KF, Carcillo JA. Hyperferritinemia and inflammation. International immunology. 2017;29(9):401–409. doi: 10.1093/intimm/dxx031
- Weiss G. Anemia of Chronic Disorders: New Diagnostic Tools and New Treatment Strategies. Seminars in hematology. 2015;52(4):313–320. doi: 10.1053/j.seminhematol.2015.07.004
- Soon E, Treacy CM, Toshner MR, et al. Unexplained iron deficiency in idiopathic and heritable pulmonary arterial hypertension. Thorax. 2011;66(4):326–332. doi: 10.1136/thx.2010.147272
- Kramer T, Wissmüller M, Natsina K, et al. Ferric carboxymaltose in patients with pulmonary arterial hypertension and iron deficiency: a long-term study. Journal of cachexia, sarcopenia and muscle. 2021;12(6):1501–1512. doi: 10.1002/jcsm.12764
- Ghafourian K, Shapiro JS, Goodman L, Ardehali H. Iron and Heart Failure: Diagnosis, Therapies, and Future Directions. JACC: Basic to translational science. 2020;5(3):300–313. doi: 10.1016/j.jacbts.2019.08.009