{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:52:12Z","timestamp":1791255132238,"version":"4.1.0"},"reference-count":32,"publisher":"Elsevier BV","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2025,11,20]],"date-time":"2025-11-20T00:00:00Z","timestamp":1763596800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012330","name":"Okayama University","doi-asserted-by":"publisher","award":["1712-002"],"award-info":[{"award-number":["1712-002"]}],"id":[{"id":"10.13039\/501100012330","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["clinicalkey.com","clinicalkey.com.au","clinicalkey.es","clinicalkey.fr","clinicalkey.jp","onlinecjc.ca","elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["Canadian Journal of Cardiology"],"published-print":{"date-parts":[[2026,4]]},"DOI":"10.1016\/j.cjca.2025.11.027","type":"journal-article","created":{"date-parts":[[2025,11,25]],"date-time":"2025-11-25T00:03:47Z","timestamp":1764029027000},"page":"776-785","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Iron Deficiency in Adults With Fontan Circulation"],"prefix":"10.1016","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3807-709X","authenticated-orcid":false,"given":"Mitsutaka","family":"Nakashima","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norihisa","family":"Toh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Ejiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teiji","family":"Akagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kodai","family":"Saito","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yohei","family":"Hyodo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rie","family":"Nakayama","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takashi","family":"Miki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hironobu","family":"Toda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoichi","family":"Takaya","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Akagi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Nakagawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhiro","family":"Nishii","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toru","family":"Miyoshi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazufumi","family":"Nakamura","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Morita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinsuke","family":"Yuasa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"key":"10.1016\/j.cjca.2025.11.027_bib1","doi-asserted-by":"crossref","first-page":"e348","DOI":"10.1161\/CIR.0000000000000535","article-title":"Diagnosis and management of noncardiac complications in adults with congenital heart disease: a scientific statement from the American Heart Association","volume":"136","author":"Lui","year":"2017","journal-title":"Circulation"},{"key":"10.1016\/j.cjca.2025.11.027_bib2","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1161\/CIRCULATIONAHA.120.045597","article-title":"Fontan-associated liver disease: screening, management, and transplant considerations","volume":"142","author":"Emamaullee","year":"2020","journal-title":"Circulation"},{"key":"10.1016\/j.cjca.2025.11.027_bib3","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.121.024034","article-title":"Severe Fontan-associated liver disease and its association with mortality","volume":"12","author":"Guerrero-Chalela","year":"2023","journal-title":"J Am Heart Assoc"},{"key":"10.1016\/j.cjca.2025.11.027_bib4","doi-asserted-by":"crossref","first-page":"2149","DOI":"10.1016\/j.jacc.2023.03.421","article-title":"Clinical outcomes of adult fontan-associated liver disease and combined heart-liver transplantation","volume":"81","author":"Lewis","year":"2023","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib5","doi-asserted-by":"crossref","first-page":"2373","DOI":"10.1093\/eurheartj\/ehab826","article-title":"Predictors of long-term mortality among perioperative survivors of Fontan operation","volume":"43","author":"Inai","year":"2022","journal-title":"Eur Heart J"},{"key":"10.1016\/j.cjca.2025.11.027_bib6","doi-asserted-by":"crossref","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"10.1016\/j.cjca.2025.11.027_bib7","doi-asserted-by":"crossref","first-page":"3627","DOI":"10.1093\/eurheartj\/ehad195","article-title":"2023 Focused update of the 2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"44","author":"McDonagh","year":"2023","journal-title":"Eur Heart J"},{"key":"10.1016\/j.cjca.2025.11.027_bib8","doi-asserted-by":"crossref","first-page":"782","DOI":"10.1016\/j.jacc.2017.12.027","article-title":"The burden of iron deficiency in heart failure: therapeutic approach","volume":"71","author":"Rocha","year":"2018","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib9","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1002\/ejhf.820","article-title":"Iron deficiency and red cell indices in patients with heart failure","volume":"20","author":"Tkaczyszyn","year":"2018","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.cjca.2025.11.027_bib10","doi-asserted-by":"crossref","first-page":"1961","DOI":"10.1161\/CIRCULATIONAHA.109.874487","article-title":"Cardiac T2\u2217 magnetic resonance for prediction of cardiac complications in thalassemia major","volume":"120","author":"Kirk","year":"2009","journal-title":"Circulation"},{"key":"10.1016\/j.cjca.2025.11.027_bib11","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/j.jacc.2021.11.039","article-title":"Criteria for iron deficiency in patients with heart failure","volume":"79","author":"Masini","year":"2022","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib12","doi-asserted-by":"crossref","first-page":"3073","DOI":"10.1093\/eurheartj\/ehq356","article-title":"Predictors of morbidity and mortality in contemporary Fontan patients: results from a multicenter study including cardiopulmonary exercise testing in 321 patients","volume":"31","author":"Diller","year":"2010","journal-title":"Eur Heart J"},{"key":"10.1016\/j.cjca.2025.11.027_bib13","doi-asserted-by":"crossref","first-page":"803","DOI":"10.1002\/ejhf.1365","article-title":"Haemodynamic profiles in adult Fontan patients: associated haemodynamics and prognosis","volume":"21","author":"Miranda","year":"2019","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.cjca.2025.11.027_bib14","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1161\/CIR.0b013e31826fb946","article-title":"EACPR\/AHA Scientific statement. Clinical recommendations for cardiopulmonary exercise testing data assessment in specific patient populations","volume":"126","author":"Guazzi","year":"2012","journal-title":"Circulation"},{"key":"10.1016\/j.cjca.2025.11.027_bib15","doi-asserted-by":"crossref","first-page":"1067","DOI":"10.1016\/j.echo.2020.04.003","article-title":"Impact of anemia on exercise and pharmacologic stress echocardiography","volume":"33","author":"Bird","year":"2020","journal-title":"J Am Soc Echocardiogr"},{"key":"10.1016\/j.cjca.2025.11.027_bib16","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1007\/s00421-019-04111-y","article-title":"The effect of severe and moderate hypoxia on exercise at a fixed level of perceived exertion","volume":"119","author":"Jeffries","year":"2019","journal-title":"Eur J Appl Physiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib17","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1016\/j.ijcard.2017.04.110","article-title":"Clinical correlates and prognostic impact of impaired iron storage versus impaired iron transport in an international cohort of 1821 patients with chronic heart failure","volume":"243","author":"Moliner","year":"2017","journal-title":"Int J Cardiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib18","doi-asserted-by":"crossref","DOI":"10.3389\/fnut.2023.1249702","article-title":"Association between green tea and coffee consumption and body iron storage in Japanese men and women: a cross-sectional study from the J-MICC Study Saga","volume":"10","author":"Nanri","year":"2023","journal-title":"Front Nutr"},{"key":"10.1016\/j.cjca.2025.11.027_bib19","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1017\/S0007114517001349","article-title":"Iron deficiency without anaemia is a potential cause of fatigue: meta-analyses of randomised controlled trials and cross-sectional studies","volume":"117","author":"Yokoi","year":"2017","journal-title":"Br J Nutr"},{"key":"10.1016\/j.cjca.2025.11.027_bib20","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1111\/vox.13688","article-title":"Iron deficiency among Japanese whole-blood donors measured by serum ferritin","volume":"119","author":"Odajima","year":"2024","journal-title":"Vox Sang"},{"key":"10.1016\/j.cjca.2025.11.027_bib21","doi-asserted-by":"crossref","first-page":"2790","DOI":"10.1093\/eurheartj\/ehr130","article-title":"Iron deficiency is associated with adverse outcome in Eisenmenger patients","volume":"32","author":"Van de Bruaene","year":"2011","journal-title":"Eur Heart J"},{"key":"10.1016\/j.cjca.2025.11.027_bib22","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1016\/S0735-1097(96)00196-9","article-title":"Cerebrovascular events in adult patients with cyanotic congenital heart disease","volume":"28","author":"Ammash","year":"1996","journal-title":"J Am Coll Cardiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib23","doi-asserted-by":"crossref","first-page":"3616","DOI":"10.1093\/eurheartj\/ehz680","article-title":"Iron deficiency in worsening heart failure is associated with reduced estimated protein intake, fluid retention, inflammation, and antiplatelet use","volume":"40","author":"van der Wal","year":"2019","journal-title":"Eur Heart J"},{"key":"10.1016\/j.cjca.2025.11.027_bib24","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1002\/ejhf.467","article-title":"The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications","volume":"18","author":"Stugiewicz","year":"2016","journal-title":"Eur J Heart Fail"},{"key":"10.1016\/j.cjca.2025.11.027_bib25","doi-asserted-by":"crossref","DOI":"10.1136\/openhrt-2024-002693","article-title":"Iron deficiency in patients with a Fontan circulation and its impact on exercise capacity","volume":"11","author":"van Hassel","year":"2024","journal-title":"Open Heart"},{"key":"10.1016\/j.cjca.2025.11.027_bib26","doi-asserted-by":"crossref","first-page":"616","DOI":"10.3748\/wjg.v29.i4.616","article-title":"Iron as a therapeutic target in chronic liver disease","volume":"29","author":"Kouroumalis","year":"2023","journal-title":"World J Gastroenterol"},{"key":"10.1016\/j.cjca.2025.11.027_bib27","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.12659\/MSM.896494","article-title":"The role of iron and iron overload in chronic liver disease","volume":"22","author":"Milic","year":"2016","journal-title":"Med Sci Monit"},{"key":"10.1016\/j.cjca.2025.11.027_bib28","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/j.ajpath.2021.04.005","article-title":"Hepcidin and iron metabolism in experimental liver injury","volume":"191","author":"Bloomer","year":"2021","journal-title":"Am J Pathol"},{"issue":"10266","key":"10.1016\/j.cjca.2025.11.027_bib29","doi-asserted-by":"crossref","first-page":"1895","DOI":"10.1016\/S0140-6736(20)32339-4","article-title":"Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial","volume":"396","author":"Ponikowski","year":"2020","journal-title":"Lancet"},{"issue":"10369","key":"10.1016\/j.cjca.2025.11.027_bib30","doi-asserted-by":"crossref","first-page":"2199","DOI":"10.1016\/S0140-6736(22)02083-9","article-title":"Intravenous ferric derisomaltose in patients with heart failure and iron deficiency in the UK (IRONMAN): an investigator-initiated, prospective, randomised, open-label, blinded-end point trial","volume":"400","author":"Kalra","year":"2022","journal-title":"Lancet"},{"key":"10.1016\/j.cjca.2025.11.027_bib31","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.ijcard.2018.05.062","article-title":"Use of intravenous iron in cyanotic patients with congenital heart disease and\/or pulmonary hypertension","volume":"267","author":"Blanche","year":"2018","journal-title":"Int J Cardiol"},{"key":"10.1016\/j.cjca.2025.11.027_bib32","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1038\/nrcardio.2014.104","article-title":"Expert consensus document: World Heart Federation expert consensus statement on antiplatelet therapy in East Asian patients with ACS or undergoing PCI","volume":"11","author":"Levine","year":"2014","journal-title":"Nat Rev Cardiol"}],"container-title":["Canadian Journal of Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0828282X25014357?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S0828282X25014357?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T02:14:35Z","timestamp":1791252875000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S0828282X25014357"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":32,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["S0828282X25014357"],"URL":"https:\/\/doi.org\/10.1016\/j.cjca.2025.11.027","relation":{},"ISSN":["0828-282X"],"issn-type":[{"value":"0828-282X","type":"print"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Impact of Iron Deficiency in Adults With Fontan Circulation","name":"articletitle","label":"Article Title"},{"value":"Canadian Journal of Cardiology","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.cjca.2025.11.027","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2025 The Authors. Published by Elsevier Inc. on behalf of the Canadian Cardiovascular Society.","name":"copyright","label":"Copyright"}]}}