• Ewa A Jankowska, Monika Kasztura, Mateusz Sokolski, Marek Bronisz, Sylwia Nawrocka, Weronika Oleśkowska-Florek, Robert Zymliński, Jan Biegus, Paweł Siwołowski, Waldemar Banasiak, Stefan D Anker, Gerasimos Filippatos, John G F Cleland, and Piotr Ponikowski.
• Laboratory for Applied Research on Cardiovascular System, Department of Heart Diseases, Wrocław Medical University, Wrocław, Poland Cardiology Department, Centre for Heart Diseases, Military Hospital, ul. Weigla 5, Wrocław 50-981, Poland ewa.jankowska@umed.wroc.pl.
• Eur. Heart J. 2014 Sep 21; 35 (36): 2468-76.

AimAcute heart failure (AHF) critically deranges haemodynamic and metabolic homoeostasis. Iron is a key micronutrient for homoeostasis maintenance. We hypothesized that iron deficiency (ID) defined as depleted iron stores accompanied by unmet cellular iron requirements would in this setting predict the poor outcome.Methods And ResultsAmong 165 AHF patients (age 65 ± 12 years, 81% men, 31% de novo HF), for ID diagnosis we prospectively applied: low serum hepcidin reflecting depleted iron stores (<14.5 ng/mL, the 5th percentile in healthy peers), and high-serum soluble transferrin receptor (sTfR) reflecting unmet cellular iron requirements (≥1.59 mg/L, the 95th percentile in healthy peers). Concomitance of low hepcidin and high sTfR (the most profound ID) was found in 37%, isolated either high sTfR or low hepcidin was found in 29 and 9% of patients, and 25% of subjects demonstrated preserved iron status. Patients with low hepcidin and high sTfR had peripheral oedema, high NT-proBNP, high uric acid, low haemoglobin (P < 0.05), and 5% in-hospital mortality (0% in remaining patients). During the 12-month follow-up, 33 (20%) patients died. Those with low hepcidin and high sTfR had the highest 12-month mortality [(41% (95% CI: 29-53%)] when compared with those with isolated high sTfR [15% (5-25%)], isolated low hepcidin [7% (0-19%)] and preserved iron status (0%) (P < 0.001). Analogous mortality patterns were seen separately in anaemics and non-anaemics.ConclusionIron deficiency defined as depleted body iron stores and unmet cellular iron requirements is common in AHF, and identifies those with the poor outcome. Its correction may be an attractive therapeutic approach.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: journals.permissions@oup.com.

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