{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T14:31:59Z","timestamp":1792506719257,"version":"4.5.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"},{"start":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T00:00:00Z","timestamp":1732752000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Uncertainty exists about defining true iron deficiency (ID) in heart failure (HF) patients. We assessed the relationship of different ID definitions with cardiac structure and function, congestion, exercise capacity, and prognosis in HF outpatients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>Iron deficiency was defined according to guidelines (G-ID: ferritin &amp;lt;100\u2009ng\/ml or ferritin 100\u2013299\u2009ng\/ml with transferrin saturation [TSAT] &amp;lt;20%). Alternative ID definitions based on TSAT (&amp;lt;20%), iron (\u226413 \u03bcmol\/L), and ferritin (&amp;lt;100 or\u2009&amp;lt;\u2009300\u2009ng\/ml) were explored. Relationships with rest\/exercise measures of cardiac function and congestion using ultrasound, effort intolerance and adverse outcome (HF hospitalizations or all-cause mortality) were assessed. Of 1502 patients (72% with left ventricular ejection fraction [LVEF] \u226550%), 471 (31%) had TSAT &amp;lt;20%, while 728 (48%) had G-ID. Patients with TSAT &amp;lt;20% or G-ID had greater left atrial volume but similar LVEF. Lower TSAT, iron and haemoglobin, but not ferritin, were associated with more signs of congestion by ultrasound. After correcting for multiple clinical variables, including haemoglobin, TSAT was directly associated with peak oxygen uptake (standardized coefficient 0.069, p\u2009=\u20090.041), while ferritin was not. There was no interaction with HF phenotype (HF with preserved vs. reduced LVEF). During a median follow-up of 18\u2009months, TSAT &amp;lt;20% and iron \u226413 \u03bcmol\/L were associated with worse outcomes in models adjusted for clinical variables, including LVEF and N-terminal pro-B-type natriuretic peptide (hazard ratio 2.48, 95% confidence interval 1.88\u20133.17 and 1.93, 1.48\u20132.52, respectively), while G-ID or ferritin &amp;lt;100 or &amp;lt;300\u2009ng\/ml were not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In HF outpatients, TSAT &amp;lt;20% is more consistently associated with congestion by ultrasound and poorer functional capacity than other ID definitions, irrespective of LVEF. TSAT &amp;lt;20% and iron \u226413 \u03bcmol\/L, but not G-ID or ferritin-based ID, predict a worse prognosis in HF outpatients with preserved and reduced LVEF.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.3534","type":"journal-article","created":{"date-parts":[[2024,11,28]],"date-time":"2024-11-28T08:30:07Z","timestamp":1732782607000},"page":"889-900","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Associations of Iron Deficiency with Cardiac Function, Congestion, Exercise Capacity and Prognosis in Heart Failure"],"prefix":"10.1093","volume":"27","author":[{"given":"Nicol\u00f2","family":"De Biase","sequence":"first","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Del Punta","sequence":"additional","affiliation":[{"name":"Department of Clinical and Experimental Medicine, University of Pisa , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wouter","family":"L'Hoyes","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jessa Hospital , Hasselt ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierpaolo","family":"Pellicori","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John G.F.","family":"Cleland","sequence":"additional","affiliation":[{"name":"School of Cardiovascular and Metabolic Health, University of Glasgow , Glasgow ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Masini","sequence":"additional","affiliation":[{"name":"Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luna","family":"Gargani","sequence":"additional","affiliation":[{"name":"Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana , Pisa ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Moura-Ferreira","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jessa Hospital , Hasselt ,","place":["Belgium"]},{"name":"UHasselt, Faculty of Rehabilitation Sciences, Rehabilitation Research Center , Diepenbeek ,","place":["Belgium"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Hoedemakers","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Jessa Hospital , Hasselt ,","place":["Belgium"]},{"name":"UHasselt, Faculty of Rehabilitation Sciences, Rehabilitation Research Center , Diepenbeek 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