{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,20]],"date-time":"2026-03-20T03:07:38Z","timestamp":1773976058130,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T00:00:00Z","timestamp":1723507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Departament de Salut de la Generalitat de Catalunya through \u201cPla Estrat\u00e8gic de Recerca i Innovaci\u00f3 en Salut (PERIS 2023)\u201d","award":["SLT028\/23\/000018"],"award-info":[{"award-number":["SLT028\/23\/000018"]}]},{"name":"Departament de Salut de la Generalitat de Catalunya through \u201cPla Estrat\u00e8gic de Recerca i Innovaci\u00f3 en Salut (PERIS 2023)\u201d","award":["2021 SGR 00455"],"award-info":[{"award-number":["2021 SGR 00455"]}]},{"name":"Departament de Recerca i Universitats de la Generalitat de Catalunya and AGAUR","award":["SLT028\/23\/000018"],"award-info":[{"award-number":["SLT028\/23\/000018"]}]},{"name":"Departament de Recerca i Universitats de la Generalitat de Catalunya and AGAUR","award":["2021 SGR 00455"],"award-info":[{"award-number":["2021 SGR 00455"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background. Iron deficiency (ID) is a significant, high-prevalence comorbidity in chronic heart failure (HF) that represents an independent predictor of a worse prognosis. However, a clear-cut diagnosis of ID in HF patients is not assured. The soluble transferrin receptor (sTfR) is a marker that reflects tissue-level iron demand and may be an early marker of ID. However, the impact of sTfR levels on clinical outcomes in non-anemic HF patients with a normal systemic iron status has never been evaluated. Methods. This is a post hoc analysis of an observational, prospective cohort study of 1236 patients with chronic HF of which only those with normal hemoglobin levels and a normal systemic iron status were studied. The final cohort consisted of 215 patients. Tissue ID was defined as levels of sTfR &gt; 75th percentile (1.65 mg\/L). Our aim was to describe the association between sTfR and clinical outcomes (all-cause death and HF hospitalization) and to explore its association with a wide array of serum biomarkers. Results. The sTfR level (HR 1.48, 95% CI 1.13\u20131.96, p = 0.005) and tissue ID (HR 2.14, 95% CI 1.22\u20133.75, p = 0.008) was associated with all-cause death. However, we found no association between sTfR levels and the risk of HF hospitalization. Furthermore, high sTfR levels were associated with a worse biomarker profile indicating myocardial damage (troponin and NT-proBNP), systemic inflammation (CRP and albumin), and impaired erythropoiesis (erythropoietin). Conclusions. In this cohort, the presence of tissue ID defined by sTfR levels is an independent factor for all-cause death in patients with normal systemic iron parameters.<\/jats:p>","DOI":"10.3390\/jcm13164742","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T06:02:37Z","timestamp":1723528957000},"page":"4742","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Prognostic Role of Tissue Iron Deficiency Measured by sTfR Levels in Heart Failure Patients without Systemic Iron Deficiency or Anemia"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7475-4145","authenticated-orcid":false,"given":"Ra\u00fal","family":"Ramos-Polo","sequence":"first","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2916-2374","authenticated-orcid":false,"given":"Maria del Mar","family":"Ras-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Department of Internal Medicine, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josep","family":"Francesch Manzano","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Jovells-Vaqu\u00e9","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Herminio","family":"Morillas Climent","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Pons-Riverola","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sergi","family":"Yun Viladomat","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Department of Internal Medicine, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5511-8597","authenticated-orcid":false,"given":"Pedro","family":"Moliner Borja","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3734-4777","authenticated-orcid":false,"given":"Carles","family":"Diez-Lopez","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Advanced Heart Failure and Heart Transplant Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7437-3630","authenticated-orcid":false,"given":"Jos\u00e9","family":"Gonz\u00e1lez-Costello","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Advanced Heart Failure and Heart Transplant Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, 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Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-4975","authenticated-orcid":false,"given":"Lorena","family":"Herrador","sequence":"additional","affiliation":[{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Advanced Heart Failure and Heart Transplant Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fernando","family":"de Frutos Seminario","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Advanced Heart Failure and Heart Transplant Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7916-1223","authenticated-orcid":false,"given":"Cristina","family":"Enjuanes Grau","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Tajes Ordu\u00f1a","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8780-720X","authenticated-orcid":false,"given":"Josep","family":"Comin-Colet","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain"},{"name":"Department of Clinical Sciences, School of Medicine, University of Barcelona, 08007 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3272","DOI":"10.1093\/cvr\/cvac013","article-title":"Global burden of heart failure: A comprehensive and updated review of epidemiology","volume":"118","author":"Savarese","year":"2023","journal-title":"Cardiovasc. 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