{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T07:00:44Z","timestamp":1782284444829,"version":"3.54.5"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"22","license":[{"start":{"date-parts":[[2023,3,5]],"date-time":"2023-03-05T00:00:00Z","timestamp":1677974400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100002291","name":"Pulmonary Hypertension Association","doi-asserted-by":"publisher","award":["U01 HL125218 (PI: E.B.R.)"],"award-info":[{"award-number":["U01 HL125218 (PI: E.B.R.)"]}],"id":[{"id":"10.13039\/100002291","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002291","name":"Pulmonary Hypertension Association","doi-asserted-by":"publisher","award":["U01 HL125205 (PI: R.P.F.)"],"award-info":[{"award-number":["U01 HL125205 (PI: R.P.F.)"]}],"id":[{"id":"10.13039\/100002291","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002291","name":"Pulmonary Hypertension Association","doi-asserted-by":"publisher","award":["U01 HL125212 (PI: A.R.H.)"],"award-info":[{"award-number":["U01 HL125212 (PI: A.R.H.)"]}],"id":[{"id":"10.13039\/100002291","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002291","name":"Pulmonary Hypertension Association","doi-asserted-by":"publisher","award":["U01 HL125208 (PI: F.P.R.)"],"award-info":[{"award-number":["U01 HL125208 (PI: F.P.R.)"]}],"id":[{"id":"10.13039\/100002291","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002291","name":"Pulmonary Hypertension Association","doi-asserted-by":"publisher","award":["U01 HL125215 (PI: J.A.L.)"],"award-info":[{"award-number":["U01 HL125215 (PI: J.A.L.)"]}],"id":[{"id":"10.13039\/100002291","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100002291","name":"Pulmonary Hypertension Association","doi-asserted-by":"publisher","award":["U01 HL125177"],"award-info":[{"award-number":["U01 HL125177"]}],"id":[{"id":"10.13039\/100002291","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001491","name":"Belgian American Educational Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100001491","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Frans van de Werf"},{"DOI":"10.13039\/100000002","name":"NIH","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Aims<\/jats:title>\n                  <jats:p>Iron deficiency is common in pulmonary hypertension, but its clinical significance and optimal definition remain unclear.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods and results<\/jats:title>\n                  <jats:p>Phenotypic data for 1028 patients enrolled in the Redefining Pulmonary Hypertension through Pulmonary Vascular Disease Phenomics study were analyzed. Iron deficiency was defined using the conventional heart failure definition and also based upon optimal cut-points associated with impaired peak oxygen consumption (peakVO2), 6-min walk test distance, and 36-Item Short Form Survey (SF-36) scores. The relationships between iron deficiency and cardiac and pulmonary vascular function and structure and outcomes were assessed. The heart failure definition of iron deficiency endorsed by pulmonary hypertension guidelines did not identify patients with reduced peakVO2, 6-min walk test, and SF-36 (P &amp;gt; 0.208 for all), but defining iron deficiency as transferrin saturation (TSAT) &amp;lt;21% did. Compared to those with TSAT \u226521%, patients with TSAT &amp;lt;21% demonstrated lower peakVO2 [absolute difference: \u22121.89 (\u22122.73 to \u22121.04) mL\/kg\/min], 6-min walk test distance [absolute difference: \u221234 (\u221251 to \u221217) m], and SF-36 physical component score [absolute difference: \u22122.5 (\u22121.3 to \u22123.8)] after adjusting for age, sex, and hemoglobin (all P &amp;lt; 0.001). Patients with a TSAT &amp;lt;21% had more right ventricular remodeling on cardiac magnetic resonance but similar pulmonary vascular resistance on catheterization. Transferrin saturation &amp;lt;21% was also associated with increased mortality risk (hazard ratio 1.63, 95% confidence interval 1.13\u20132.34; P = 0.009) after adjusting for sex, age, hemoglobin, and N-terminal pro-B-type natriuretic peptide.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The definition of iron deficiency in the 2022 European Society of Cardiology (ESC)\/European Respiratory Society (ERS) pulmonary hypertension guidelines does not identify patients with lower exercise capacity or functional status, while a definition of TSAT &amp;lt;21% identifies patients with lower exercise capacity, worse functional status, right heart remodeling, and adverse clinical outcomes.<\/jats:p>\n               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Emanuel","family":"Finet","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart Vascular and Thoracic Institute, Cleveland Clinic , 9500 Euclid Avenue, Desk J3-4, Cleveland, OH 44195 , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Grunig","sequence":"additional","affiliation":[{"name":"Department of Medicine & Environmental Medicine, New York University Grossman School of Medicine , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna R","family":"Hemnes","sequence":"additional","affiliation":[{"name":"Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center , Nashville, TN , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas S","family":"Hill","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, Tufts Medical Center , Boston, MA , 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