Deficiência de ferro intramiocárdico avaliado por ressonância magnética cardíaca em pacientes com insuficiência cardíaca com fração de ejeção reduzida

Quadro Teórico. A ferropenia tem sido alvo terapêutico em pacientes com insuficiência cardíaca com fração de ejeção reduzida (ICFER). A reposição de ferro por via endovenosa parece ter efeito funcional sobre a eficiência muscular. Não é sabido se a deficiência de ferro intramiocárdico está correlacionada com ferropenia. Objetivos. Avaliar a correlação da sequência T2* na ressonância magnética cardíaca (RMC) com marcadores séricos do ferro em pacientes com insuficiência cardíaca. Métodos. Este estudo transversal incluiu pacientes ≥ 18 anos com insuficiência cardíaca, FE≤ 50% e RMC. Coeficiente de correlação de Pearson e Teste t para amostras independentes foram realizados. Resultados. Foram analisados 47 pacientes. O valor médio T2* e a FEVE na RMC foram de 36,5±6,6 ms e 30,7±12%, respectivamente. A principal etiologia foi não isquêmica (76,6%). Deficiência de ferro ocorreu em 40,4%. Não houve correlação entre T2 * e saturação de transferrina (r = - 0,063, P = 0,678), ferritina (r = - 0,164, P = 0,272) e ferro (r = 0,099, P = 0,512). A idade (r = - 0,330; P = 0,024) e a frequência cardíaca em repouso (r = - 0,427; P = 0,003) foram correlacionadas. Conclusão. A sequência T2* na RMC não teve correlação com a saturação da transferrina, ferritina ou ferro sérico.Background. The iron deficiency has been a therapeutic target in patients with heart failure with reduced ejection fraction (HFrEF). The iron endovenous treatment appear to have functional effect in muscle efficiency. It remains unknown if intramyocardial iron lack is correlated with iron deficiency. Objectives. Assess the correlation of T2* sequence in cardiac magnetic resonance (CMR) with blood tests for iron metabolism in patients with heart failure (HF). Methods. This cross-sectional study included patients ≥ 18 years with symptomatic HF, left ventricular ejection fraction ≤ 50% and that had a CMR. Pearson correlation coefficient and Independent Samples t-Test were performed. Results. A total of 47 patients were analyzed. The mean T2* value and LVEF in CMR were 36,5±6,6 ms and 30,7±12% respectively. The main etiology’s HF was non-ischemic (76,6%). The diagnosis of iron deficiency was done in 40,4%. No significant correlation was found between T2* and transferrin saturation (r= - 0,063, P=0,678), ferritin (r= - 0,164, P=0,272) and iron (r= 0,099, P=0,512). The age was negatively correlated (r= - 0,330; P= 0,024) and heart rate at rest (r= - 0,427; P= 0,003) too. Conclusion. The T2* sequence in CMR had no correlation with transferrin saturation, ferritin or serum iron

Iron deficiency in heart failure with reduced ejection fraction : pathophysiology, diagnosis and treatment

A deficiência de ferro (DF) ou ferropenia é uma importante comorbidade na insuficiência cardíaca com fração de ejeção reduzida (ICFER) estável, e muito prevalente tanto nos anêmicos como não anêmicos. A ferropenia na ICFER deve ser pesquisada por meio da coleta de saturação de transferrina e ferritina. Há dois tipos de ferropenia na IC: absoluta, em que as reservas de ferro estão depletadas; e funcional, onde o suprimento de ferro é inadequado apesar das reservas normais. A ferropenia está associada com pior classe funcional e maior risco de morte em pacientes com ICFER, e evidências científicas apontam melhora de sintomas e de qualidade de vida desses pacientes com tratamento com ferro parenteral na forma de carboximaltose férrica. O ferro exerce funções imprescindíveis como o transporte (hemoglobina) e armazenamento (mioglobina) de oxigênio, além de ser fundamental para o funcionamento das mitocôndrias, constituídas de proteínas à base de ferro, e local de geração de energia na cadeia respiratória pelo metabolismo oxidativo. A geração insuficiente e utilização anormal de ferro nas células musculares esquelética e cardíaca contribuem para a fisiopatologia da IC. A presente revisão tem o objetivo de aprofundar o conhecimento a respeito da fisiopatologia da ferropenia na ICFER, abordar as ferramentas disponíveis para o diagnóstico e discutir sobre a evidência científica existente de reposição de ferro.Iron deficiency (ID) is an important comorbidity in heart failure with reduced ejection (HFrEF) and is highly prevalent in both anemic and non-anemic patients. In HFrEF, iron deficiency should be investigated by measurements of transferrin saturation and ferritin. There are two types of ID: absolute deficiency, with depletion of iron stores; and functional ID, where iron supply is not sufficient despite normal stores. ID is associated with worse functional class and higher risk of death in patients with HFrEF, and scientific evidence has indicated improvement of symptoms and quality of life of these patients with treatment with parenteral iron in the form of ferric carboxymaltose. Iron plays vital roles such as oxygen transportation (hemoglobin) and storage (myoblogin), and is crucial for adequate functioning of mitochondria, which are composed of iron-based proteins and the place of energy generation by oxidative metabolism at the electron transport chain. An insufficient generation and abnormal uptake of iron by skeletal and cardiac muscle cells contribute to the pathophysiology of HF. The present review aims to increase the knowledge of the pathophysiology of ID in HFrEF, and to address available tools for its diagnosis and current scientific evidence on iron replacement therapy

Helicobacter pylori and anemia: a community-based cross-sectional study among adults in Southern Brazil

To investigate the association between Helicobacter pylori and anemia, a community-based cross-sectional study was conducted among 18-45 year old users of the 31 primary health care units in Pelotas, Southern Brazil. Interviews using a structured questionnaire were carried out in waiting rooms during two work shifts. Anemia (hemoglobin < 11g/dL among pregnant women, < 12g/dL among women and < 13g/dL among men) was diagnosed from capillary blood (HemoCue) and H. pylori by means of a 13C-UBT. Information on socio-demographic, behavioral and biological characteristics was collected. Logistic and linear regression analyses were carried out, taking into account aggregated primary health care units. A total of 1,117 respondents fulfilled the inclusion criteria (losses/refusals: 8.1%). Prevalence of anemia was 20.6% (18.2-23.2%) and of H. pylori, 70.7% (68.0-73.6%). After allowing for age, sex and skin color the odds ratio for anemia among those who were diagnosed H. pylori positive was 0.94 (0.70-1.27). After allowing for sex, skin color, family monthly income, age, and smoking, the reduction in hemoglobin among H. pylori positive respondents was 0.07g/dL (-0.24-0.11; p = 0.4). There is no association between H. pylori and anemia among adults attending primary health care units in Southern Brazil