Relative hypochromia and mortality in acute heart failure
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Relative hypochromia and mortality in acute heart failure. / Kleber, Martina; Kozhuharov, Nikola; Sabti, Zaid; Glatz, Bettina; Isenreich, Rahel; Wussler, Desiree; Nowak, Albina; Twerenbold, Raphael; Badertscher, Patrick; Puelacher, Christian; du Fay de Lavallaz, Jeanne; Nestelberger, Thomas; Boeddinghaus, Jasper; Wildi, Karin; Flores, Dayana; Walter, Joan; Rentsch, Katharina; von Eckardstein, Arnold; Goudev, Assen; Breidthardt, Tobias; Mueller, Christian.
In: INT J CARDIOL, Vol. 286, 01.07.2019, p. 104-110.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Relative hypochromia and mortality in acute heart failure
AU - Kleber, Martina
AU - Kozhuharov, Nikola
AU - Sabti, Zaid
AU - Glatz, Bettina
AU - Isenreich, Rahel
AU - Wussler, Desiree
AU - Nowak, Albina
AU - Twerenbold, Raphael
AU - Badertscher, Patrick
AU - Puelacher, Christian
AU - du Fay de Lavallaz, Jeanne
AU - Nestelberger, Thomas
AU - Boeddinghaus, Jasper
AU - Wildi, Karin
AU - Flores, Dayana
AU - Walter, Joan
AU - Rentsch, Katharina
AU - von Eckardstein, Arnold
AU - Goudev, Assen
AU - Breidthardt, Tobias
AU - Mueller, Christian
N1 - Copyright © 2019 Elsevier B.V. All rights reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - BACKGROUND: Relative hypochromia of erythrocytes defined as a reduced mean corpuscular hemoglobin concentration (MCHC) is a surrogate of iron deficiency. We aimed to evaluate the prevalence and prognostic impact of relative hypochromia in acute heart failure (AHF).METHODS: We prospectively characterized 1574 patients presenting with an adjudicated diagnosis of AHF to the emergency department. Relative hypochromia was defined as a MCHC ≤330 g/l and determined at presentation. The presence of AHF was adjudicated by two independent cardiologists. All-cause mortality and AHF-rehospitalization were the primary prognostic end-points.RESULTS: Overall, 455 (29%) AHF patients had relative hypochromia. Patients with relative hypochromia had higher hemodynamic cardiac stress as quantified by NT-proBNP concentrations (p < 0.001), more extensive cardiomyocyte injury as quantified by high-sensitive cardiac troponin T (hs-cTnT) concentrations (p < 0.001), and lower estimated glomerular filtration rate (eGFR; p < 0.001) as compared to AHF patients without hypochromia. Cumulative incidences for all-cause mortality and AHF-rehospitalization at 720-days were 50% and 55% in patients with relative hypochromia as compared to 33% and 39% in patients without hypochromia, respectively (both p < 0.0001). The association between relative hypochromia and increased mortality (HR 1.7, 95% CI 1.4-2-0) persisted after adjusting for anemia (HR 1.5, 95% CI 1.3-1.8), and after adjusting for hemodynamic cardiac stress (HR 1.46, 95% CI 1.21-1.76) and eGFR (HR 1.5, 95% CI 1.3-1.8, p < 0.001).CONCLUSIONS: Relative hypochromia is common and a strong and independent predictor of increased mortality in AHF. Given the direct link to diagnostic (endoscopy) and therapeutic interventions to treat functional iron deficiency, relative hypochromia deserves increased attention as an inexpensive and universally available biomarker.
AB - BACKGROUND: Relative hypochromia of erythrocytes defined as a reduced mean corpuscular hemoglobin concentration (MCHC) is a surrogate of iron deficiency. We aimed to evaluate the prevalence and prognostic impact of relative hypochromia in acute heart failure (AHF).METHODS: We prospectively characterized 1574 patients presenting with an adjudicated diagnosis of AHF to the emergency department. Relative hypochromia was defined as a MCHC ≤330 g/l and determined at presentation. The presence of AHF was adjudicated by two independent cardiologists. All-cause mortality and AHF-rehospitalization were the primary prognostic end-points.RESULTS: Overall, 455 (29%) AHF patients had relative hypochromia. Patients with relative hypochromia had higher hemodynamic cardiac stress as quantified by NT-proBNP concentrations (p < 0.001), more extensive cardiomyocyte injury as quantified by high-sensitive cardiac troponin T (hs-cTnT) concentrations (p < 0.001), and lower estimated glomerular filtration rate (eGFR; p < 0.001) as compared to AHF patients without hypochromia. Cumulative incidences for all-cause mortality and AHF-rehospitalization at 720-days were 50% and 55% in patients with relative hypochromia as compared to 33% and 39% in patients without hypochromia, respectively (both p < 0.0001). The association between relative hypochromia and increased mortality (HR 1.7, 95% CI 1.4-2-0) persisted after adjusting for anemia (HR 1.5, 95% CI 1.3-1.8), and after adjusting for hemodynamic cardiac stress (HR 1.46, 95% CI 1.21-1.76) and eGFR (HR 1.5, 95% CI 1.3-1.8, p < 0.001).CONCLUSIONS: Relative hypochromia is common and a strong and independent predictor of increased mortality in AHF. Given the direct link to diagnostic (endoscopy) and therapeutic interventions to treat functional iron deficiency, relative hypochromia deserves increased attention as an inexpensive and universally available biomarker.
KW - Acute Disease
KW - Aged
KW - Aged, 80 and over
KW - Anemia, Hypochromic/blood
KW - Biomarkers/blood
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/complications
KW - Humans
KW - Incidence
KW - Iron/blood
KW - Male
KW - Prognosis
KW - Prospective Studies
KW - Risk Factors
KW - Survival Rate/trends
KW - Switzerland/epidemiology
U2 - 10.1016/j.ijcard.2019.02.060
DO - 10.1016/j.ijcard.2019.02.060
M3 - SCORING: Journal article
C2 - 30853296
VL - 286
SP - 104
EP - 110
JO - INT J CARDIOL
JF - INT J CARDIOL
SN - 0167-5273
ER -
