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Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study

AIMS: Iron deficiency (ID) is linked to reduced aerobic exercise capacity and poor prognosis in patients with heart failure (HF) with reduced ejection fraction (HFrEF); however, data for HF with preserved ejection fraction (HFpEF) is scarce. We assessed the relationship between iron status and diast...

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Autores principales: Gevaert, Andreas B., Mueller, Stephan, Winzer, Ephraim B., Duvinage, André, Van de Heyning, Caroline M., Pieske-Kraigher, Elisabeth, Beckers, Paul J., Edelmann, Frank, Wisløff, Ulrik, Pieske, Burkert, Adams, Volker, Halle, Martin, Van Craenenbroeck, Emeline M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866976/
https://www.ncbi.nlm.nih.gov/pubmed/35222057
http://dx.doi.org/10.3389/fphys.2021.757268
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author Gevaert, Andreas B.
Mueller, Stephan
Winzer, Ephraim B.
Duvinage, André
Van de Heyning, Caroline M.
Pieske-Kraigher, Elisabeth
Beckers, Paul J.
Edelmann, Frank
Wisløff, Ulrik
Pieske, Burkert
Adams, Volker
Halle, Martin
Van Craenenbroeck, Emeline M.
author_facet Gevaert, Andreas B.
Mueller, Stephan
Winzer, Ephraim B.
Duvinage, André
Van de Heyning, Caroline M.
Pieske-Kraigher, Elisabeth
Beckers, Paul J.
Edelmann, Frank
Wisløff, Ulrik
Pieske, Burkert
Adams, Volker
Halle, Martin
Van Craenenbroeck, Emeline M.
author_sort Gevaert, Andreas B.
collection PubMed
description AIMS: Iron deficiency (ID) is linked to reduced aerobic exercise capacity and poor prognosis in patients with heart failure (HF) with reduced ejection fraction (HFrEF); however, data for HF with preserved ejection fraction (HFpEF) is scarce. We assessed the relationship between iron status and diastolic dysfunction as well as aerobic exercise capacity in HFpEF, and the contribution of iron status to patient phenotyping. METHODS AND RESULTS: Among 180 patients with HFpEF (66% women; median age, 71 years) recruited for the Optimizing Exercise Training in Prevention and Treatment of Diastolic HF (OptimEx-Clin) trial, baseline iron status, including iron, ferritin, and transferrin saturation, was analyzed (n = 169) in addition to exercise capacity (peak oxygen uptake [peak V̇O(2)]) and diastolic function (E/e′). ID was present in 60% of patients and was more common in women. In multivariable linear regression models, we found that diastolic function and peak V̇O(2) were independently related to iron parameters; however, these relationships were present only in patients with HFpEF and ID [E/e′ and iron: β−0.19 (95% confidence interval −0.32, −0.07), p = 0.003; E/e′ and transferrin saturation: β−0.16 (−0.28, −0.04), p = 0.011; peak V̇O(2) and iron: β 3.76 (1.08, 6.44), p = 0.007; peak V̇O(2) and transferrin saturation: β 3.58 (0.99, 6.16), p = 0.007]. Applying machine learning, patients were classified into three phenogroups. One phenogroup was predominantly characterized by the female sex and few HFpEF risk factors but a high prevalence of ID (86%, p < 0.001 vs. other phenogroups). When excluding ID from the phenotyping analysis, results were negatively influenced. CONCLUSION: Iron parameters are independently associated with impaired diastolic function and low aerobic capacity in patients with HFpEF and ID. Patient phenotyping in HFpEF is influenced by including ID. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT02078947.
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spelling pubmed-88669762022-02-25 Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study Gevaert, Andreas B. Mueller, Stephan Winzer, Ephraim B. Duvinage, André Van de Heyning, Caroline M. Pieske-Kraigher, Elisabeth Beckers, Paul J. Edelmann, Frank Wisløff, Ulrik Pieske, Burkert Adams, Volker Halle, Martin Van Craenenbroeck, Emeline M. Front Physiol Physiology AIMS: Iron deficiency (ID) is linked to reduced aerobic exercise capacity and poor prognosis in patients with heart failure (HF) with reduced ejection fraction (HFrEF); however, data for HF with preserved ejection fraction (HFpEF) is scarce. We assessed the relationship between iron status and diastolic dysfunction as well as aerobic exercise capacity in HFpEF, and the contribution of iron status to patient phenotyping. METHODS AND RESULTS: Among 180 patients with HFpEF (66% women; median age, 71 years) recruited for the Optimizing Exercise Training in Prevention and Treatment of Diastolic HF (OptimEx-Clin) trial, baseline iron status, including iron, ferritin, and transferrin saturation, was analyzed (n = 169) in addition to exercise capacity (peak oxygen uptake [peak V̇O(2)]) and diastolic function (E/e′). ID was present in 60% of patients and was more common in women. In multivariable linear regression models, we found that diastolic function and peak V̇O(2) were independently related to iron parameters; however, these relationships were present only in patients with HFpEF and ID [E/e′ and iron: β−0.19 (95% confidence interval −0.32, −0.07), p = 0.003; E/e′ and transferrin saturation: β−0.16 (−0.28, −0.04), p = 0.011; peak V̇O(2) and iron: β 3.76 (1.08, 6.44), p = 0.007; peak V̇O(2) and transferrin saturation: β 3.58 (0.99, 6.16), p = 0.007]. Applying machine learning, patients were classified into three phenogroups. One phenogroup was predominantly characterized by the female sex and few HFpEF risk factors but a high prevalence of ID (86%, p < 0.001 vs. other phenogroups). When excluding ID from the phenotyping analysis, results were negatively influenced. CONCLUSION: Iron parameters are independently associated with impaired diastolic function and low aerobic capacity in patients with HFpEF and ID. Patient phenotyping in HFpEF is influenced by including ID. CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov, identifier NCT02078947. Frontiers Media S.A. 2022-02-10 /pmc/articles/PMC8866976/ /pubmed/35222057 http://dx.doi.org/10.3389/fphys.2021.757268 Text en Copyright © 2022 Gevaert, Mueller, Winzer, Duvinage, Van de Heyning, Pieske-Kraigher, Beckers, Edelmann, Wisløff, Pieske, Adams, Halle and Van Craenenbroeck. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Physiology
Gevaert, Andreas B.
Mueller, Stephan
Winzer, Ephraim B.
Duvinage, André
Van de Heyning, Caroline M.
Pieske-Kraigher, Elisabeth
Beckers, Paul J.
Edelmann, Frank
Wisløff, Ulrik
Pieske, Burkert
Adams, Volker
Halle, Martin
Van Craenenbroeck, Emeline M.
Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study
title Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study
title_full Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study
title_fullStr Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study
title_full_unstemmed Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study
title_short Iron Deficiency Impacts Diastolic Function, Aerobic Exercise Capacity, and Patient Phenotyping in Heart Failure With Preserved Ejection Fraction: A Subanalysis of the OptimEx-Clin Study
title_sort iron deficiency impacts diastolic function, aerobic exercise capacity, and patient phenotyping in heart failure with preserved ejection fraction: a subanalysis of the optimex-clin study
topic Physiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8866976/
https://www.ncbi.nlm.nih.gov/pubmed/35222057
http://dx.doi.org/10.3389/fphys.2021.757268
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