Clinical Epidemiology and Ageing

Prevalence and determinants of iron deficiency in cardiac amyloidosis.

Jobbé-Duval A, Bezard M, Moutereau S, Kharoubi M, Oghina S, Zaroui A, Galat A, Chalard C, Hugon-Vallet E, Lemonnier F, Eyharts D, Poulot E, Fanen P, Funalot B, Molinier-Frenkel V, Audard V, Hittinger L, Delbarre MAntoine, Teiger E, Damy T ESC Heart Fail. 2022;9(2):1314-1327.

AIMS: Iron deficiency (ID) is common in patient with chronic heart failure (HF) and has been widely studied. In contrast, data concerning ID in cardiac amyloidosis (CA) are limited. Amyloidosis is a severe and fatal systemic disease, characterized by an accumulation of amyloid fibrils in various tissues/organs, including nerves, kidneys, gastrointestinal tract, and heart. Amyloid deposits in the heart eventually cause HF. The main subtypes of CA are light chain (AL), hereditary transthyretin (ATTRv), and wild-type transthyretin (ATTRwt). We performed this study to determine the prevalence, clinical outcome (all-cause mortality), and determinants of ID among the three main subtypes of CA.

METHODS AND RESULTS: Iron deficiency status were analysed in 816 CA patients enrolled at the French Referral Centre for Cardiac Amyloidosis: 271 (33%) had AL, 164 (20%) ATTRv, and 381 (47%) ATTRwt. ID affected 49% of CA patients, 45% with AL, 58% with ATTRv, and 48% with ATTRwt. We identified ATTR status (ATTRv P = 0.003, ATTRwt P = 0.037), diabetes (P = 0.003), aspirin treatment (P = 0.009), haemoglobin levels (P = 0.006), and altered global longitudinal strain (P = 0.02) as independent ID determinants. There is no difference in all-cause mortality considering ID status.

CONCLUSIONS: Iron deficiency is common in patients with CA, irrespective of the subtype. Patients seem more likely to have ID if diagnosed with ATTR, if diabetic, and/or treated with aspirin. In CA, the benefit of intravenous iron therapy, for ID, on morbidity and mortality needs further study.

MeSH terms: Amyloid; Amyloidosis; Heart Failure; Humans; Iron Deficiencies; Prevalence
DOI: 10.1002/ehf2.13818