Heart failure & cardiomyopathiesCohort study
Transferrin Saturation Is a Better Predictor Than Ferritin of Metabolic and Hemodynamic Exercise Responses in Heart Failure with Preserved Ejection Fraction (HFpEF)
- Cohort study
- invasive hemodynamic cardiopulmonary exercise testing
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
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