{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:31:14Z","timestamp":1760059874872,"version":"build-2065373602"},"reference-count":30,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T00:00:00Z","timestamp":1753142400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Iron deficiency (ID) is a prevalent comorbidity of heart failure (HF), affecting up to 59% of patients, regardless of the presence of anaemia. Although its negative impact on left ventricular (LV) function is well documented, its effect on right ventricular (RV) function remains unclear. This study assessed the effects of ID on RV global longitudinal strain (RV-GLS) in patients diagnosed with acute decompensated HF (ADHF). Methods: This study included data from 100 patients hospitalised with ADHF irrespective of LV ejection fraction (LVEF) value. ID was defined according to the European Society of Cardiology HF guidelines as serum ferritin &lt;100 ng\/mL or ferritin 100\u2013299 ng\/mL, with transferrin saturation &lt;20%. Anaemia was defined according to World Health Organization criteria as haemoglobin level &lt;12 g\/dL in women and &lt;13 g\/dL in men. RV systolic function was assessed using parameters including RV ejection fraction (RVEF), tricuspid annular plane systolic excursion (TAPSE), RV fractional area change (FAC), peak systolic tissue Doppler velocity of the RV annulus (RV TDI S\u2032), acceleration time of the RV outflow tract, and RV free wall GLS. Results: The mean (\u00b1SD) age of the study population (64% male) was 70 \u00b1 10 years. The median LVEF was 35%, with 66% of patients classified with HF with reduced ejection fraction, 6% with HF with mid-range ejection fraction, and 28% with HF with preserved ejection fraction. Fifty-eight percent of patients had ID. There were no significant differences between patients with and without ID regarding demographics, LVEF, RV FAC, RV TDI S\u2032, or systolic pulmonary artery pressure. However, TAPSE (15.6 versus [vs.] 17.2 mm; p = 0.05) and RV free wall GLS (\u221214.7% vs. \u221218.2%; p = 0.005) were significantly lower in patients with ID, indicating subclinical RV systolic dysfunction. Conclusions: ID was associated with subclinical impairment of RV systolic function in patients diagnosed with ADHF, as evidenced by reductions in TAPSE and RV-GLS, despite the preservation of conventional RV systolic function parameters. Further research validating these findings and exploring the underlying mechanisms is warranted.<\/jats:p>","DOI":"10.3390\/jcm14155188","type":"journal-article","created":{"date-parts":[[2025,7,22]],"date-time":"2025-07-22T13:35:28Z","timestamp":1753191328000},"page":"5188","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Iron Deficiency on Right Ventricular Strain in Patients Diagnosed with Acute Heart Failure"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9038-6431","authenticated-orcid":false,"given":"Kemal","family":"Engin","sequence":"first","affiliation":[{"name":"Department of Cardiology, Istanbul University-Cerrahpasa Cardiology Institute, 34098 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4837-7099","authenticated-orcid":false,"given":"Umit Yasar","family":"Sinan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul University-Cerrahpasa Cardiology Institute, 34098 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0962-0540","authenticated-orcid":false,"given":"Sukru","family":"Arslan","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul University-Cerrahpasa Cardiology Institute, 34098 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet Serdar","family":"Kucukoglu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Istanbul University-Cerrahpasa Cardiology Institute, 34098 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/j.hfc.2019.02.005","article-title":"Anemia and iron deficiency in heart failure: Clinical and prognostic role","volume":"15","author":"Moscucci","year":"2019","journal-title":"Heart Fail. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1161\/CIRCULATIONAHA.118.030099","article-title":"Anemia and iron deficiency in heart failure: Current concepts and emerging therapies","volume":"138","author":"Anand","year":"2018","journal-title":"Circulation"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Alnuwaysir, R.I., Hoes, M.F., van Veldhuisen, D.J., van der Meer, P., and Grote Beverborg, N. (2021). Iron deficiency in heart failure: Mechanisms and pathophysiology. J. Clin. Med., 11.","DOI":"10.3390\/jcm11010125"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e022853","DOI":"10.1161\/JAHA.121.022853","article-title":"Myocardial iron deficiency and mitochondrial dysfunction in advanced heart failure in humans","volume":"11","author":"Zhang","year":"2022","journal-title":"J. Am. Heart Assoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1002\/ehf2.13265","article-title":"Iron deficiency in heart failure","volume":"8","author":"Loncar","year":"2021","journal-title":"ESC Heart Fail."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Beale, A., Carballo, D., Stirnemann, J., Garin, N., Agoritsas, T., Serratrice, J., Kaye, D., Meyer, P., and Carballo, S. (2019). Iron deficiency in acute decompensated heart failure. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101569"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1007\/s00392-021-01832-z","article-title":"Iron deficiency and short-term adverse events in patients with decompensated heart failure","volume":"110","author":"Palau","year":"2021","journal-title":"Clin. Res. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.ijcard.2014.03.169","article-title":"Iron deficiency and health-related quality of life in chronic heart failure: Results from a multicenter European study","volume":"174","author":"Enjuanes","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"4222","DOI":"10.1002\/ehf2.13053","article-title":"Short-term changes in left and right systolic function following ferric carboxymaltose: A substudy of the Myocardial-IRON trial","volume":"7","author":"Santas","year":"2020","journal-title":"ESC Heart Fail."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e06","DOI":"10.15420\/cfr.2021.26","article-title":"The effect of iron deficiency on cardiac function and structure in heart failure with reduced ejection fraction","volume":"8","author":"Martens","year":"2022","journal-title":"Card. Fail. Rev."},{"key":"ref_11","first-page":"406","article-title":"Right ventricular function and iron deficiency in acute heart failure","volume":"10","author":"Santas","year":"2021","journal-title":"Eur. Heart J. Acute Cardiovasc. Care"},{"key":"ref_12","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: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1016\/j.echo.2010.05.010","article-title":"Guidelines for the echocardiographic assessment of the right heart in adults: A report from the American Society of Echocardiography: Endorsed by the European Association of Echocardiography, a registered branch of the European Society of Cardiology, and the Canadian Society of Echocardiography","volume":"23","author":"Rudski","year":"2010","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/ehjci\/jey042","article-title":"Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: A consensus document of the EACVI\/ASE\/Industry Task Force to standardize deformation imaging","volume":"19","author":"Badano","year":"2018","journal-title":"Eur. Heart J.-Cardiovasc. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"111","DOI":"10.4250\/jcvi.2018.26.e11","article-title":"Strain analysis of the right ventricle using two-dimensional echocardiography","volume":"26","author":"Lee","year":"2018","journal-title":"J. Cardiovasc. Imaging"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1007\/s10741-018-9738-4","article-title":"Structural and functional abnormalities in iron-depleted heart","volume":"24","author":"Kobak","year":"2019","journal-title":"Heart Fail. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e125618","DOI":"10.1172\/jci.insight.125618","article-title":"Iron-deficiency anemia reduces cardiac contraction by downregulating RyR2 channels and suppressing SERCA pump activity","volume":"4","author":"Chung","year":"2019","journal-title":"JCI Insight"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3439","DOI":"10.1016\/j.ijcard.2013.04.181","article-title":"IRON-HF study: A randomized trial to assess the effects of iron in heart failure patients with anemia","volume":"168","author":"Piardi","year":"2013","journal-title":"Int. J. Cardiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1093\/eurjhf\/hfs017","article-title":"Iron supplementation for the treatment of chronic heart failure and iron deficiency: Systematic review and meta-analysis","volume":"14","author":"Avni","year":"2012","journal-title":"Eur. J. Heart Fail."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1161\/CIRCULATIONAHA.109.887570","article-title":"Effects of right ventricular ejection fraction on outcomes in chronic systolic heart failure","volume":"121","author":"Meyer","year":"2010","journal-title":"Circulation"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1002\/ejhf.873","article-title":"Right ventricular dysfunction in left-sided heart failure with preserved versus reduced ejection fraction","volume":"19","author":"Bosch","year":"2017","journal-title":"Eur. J. Heart Fail."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1007\/s11897-018-0378-8","article-title":"Right ventricular dysfunction and its contribution to morbidity and mortality in left ventricular heart failure","volume":"15","author":"Raina","year":"2018","journal-title":"Curr. Heart Fail. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1007\/s10741-021-10192-9","article-title":"Right ventricular failure: A comorbidity or a clinical emergency?","volume":"27","author":"Das","year":"2022","journal-title":"Heart Fail. Rev."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3452","DOI":"10.1093\/eurheartj\/ehu193","article-title":"Right heart dysfunction in heart failure with preserved ejection fraction","volume":"35","author":"Melenovsky","year":"2014","journal-title":"Eur. Heart J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.amjcard.2018.06.045","article-title":"Lack of association between anemia and intrinsic left ventricular diastolic function or cardiac mechanics in heart failure with preserved ejection fraction","volume":"122","author":"Burns","year":"2018","journal-title":"Am. J. Cardiol."},{"key":"ref_26","first-page":"136","article-title":"Right ventricular function assessment in sickle cell anaemia patients using echocardiography","volume":"1","author":"Oni","year":"2019","journal-title":"Haematol. Int. J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1216","DOI":"10.1016\/j.echo.2014.07.014","article-title":"Assessment of ventricular function in adults with sickle cell disease: Role of two-dimensional speckle-tracking strain","volume":"27","author":"Barbosa","year":"2014","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.jacc.2011.01.059","article-title":"Myocardial and systemic iron depletion in heart failure: Implications for anemia accompanying heart failure","volume":"58","author":"Maeder","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1925","DOI":"10.1016\/j.bbadis.2018.08.030","article-title":"Role of iron metabolism in heart failure: From iron deficiency to iron overload","volume":"1865","author":"Zhang","year":"2019","journal-title":"Biochim. Biophys. Acta (BBA)-Mol. Basis Dis."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"ehad655.929","DOI":"10.1093\/eurheartj\/ehad655.929","article-title":"The effect of iron deficiency on RV function in acute decompensated heart failure patients","volume":"44","author":"Engin","year":"2023","journal-title":"Eur. Heart J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5188\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:13:59Z","timestamp":1760033639000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/15\/5188"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,22]]},"references-count":30,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2025,8]]}},"alternative-id":["jcm14155188"],"URL":"https:\/\/doi.org\/10.3390\/jcm14155188","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2025,7,22]]}}}