Heart failure & cardiomyopathies
Transferrin Saturation Is a Better Predictor Than Ferritin of Metabolic and Hemodynamic Exercise Responses in Heart Failure with Preserved Ejection Fraction (HFpEF)
Authors' conclusion
In patients with HFpEF, Tsat%, but not ferritin levels, relates to more favorable overall metabolic and hemodynamic responses to exercise and better outcomes.
Study context
- Population
- Patients with HFpEF undergoing cardiopulmonary exercise testing with invasive hemodynamics
- Participants
- 372 patients
- Exposure
- Iron status markers vs exercise responses and outcomes
- Outcome
- Relationship of iron status markers with exercise response patterns (peak oxygen consumption, exercise hemodynamics) and clinical outcomes
Methodological detailsinvasive hemodynamic cardiopulmonary exercise testing
- Invasive hemodynamic cardiopulmonary exercise testing
Main finding
As reported in the abstract
Higher peak oxygen consumption associated with higher transferrin saturation (Tsat)% (ρ = 0.33)
P < 0.0001
Higher peak oxygen consumption associated with higher Tsat/hepcidin ratio (ρ = 0.23)
P < 0.0001
Higher peak oxygen consumption associated with higher serum iron (ρ = 0.30)
P < 0.0001
Associations with Tsat, Tsat/hepcidin and iron remained significant after adjustment for age, hypertension, diuretic use, hemoglobin and cardiac index at rest
P ≤ 0.006 for all
Observational data: associations, not effects.
Further findings
| Outcome | HR | P value |
|---|---|---|
| HF-free survival | 0.60 | P = 0.002 |
- HF-free survival: per higher tertile of Tsat; ferritin not associated with outcomes
Exercise hemodynamics (PA pressure/cardiac output slope, PCWP/cardiac output slope)
- Tsat, Tsat/hepcidin and iron associated with lower slopes; ferritin did not correlate
Iron deficiency prevalence (ferritin <100 μg/L or ferritin 100-300 μg/L with Tsat <20%)
- Iron deficiency
- 66%
Original publication
Summarised from the published abstract; every number is checked against it