Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies
Anemia and Iron Deficiency in Heart Failure: Current Concepts and Emerging Therapies
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DOI：
10.1161/circulationaha.118.030099
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发表时间：
2018-07-03
期刊：
影响因子：
37.8
通讯作者：
Gupta, Pankaj
中科院分区：
文献类型：
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作者：
Anand, Inder S.;Gupta, Pankaj
贫血和缺铁是心力衰竭患者常见的重要并存疾病。这两种情况，无论是共同的还是独立的，都与较差的临床状态和较差的结果相关。贫血和缺铁是否仅仅是心力衰竭严重程度的标志，或者它们是否介导了心力衰竭的进展和结果，因此是否应该进行治疗尚不完全清楚。在过去的几年里，红细胞生成刺激剂对心力衰竭患者贫血的治疗进行了深入的评估。不幸的是，这些药物并没有改善结果，而是与更高的不良事件风险相关。心力衰竭患者的铁缺乏可以是绝对的，当总铁减少时，或功能时，当总铁正常或增加，但不足以满足目标组织的需要，因为存储池中的隔离。尽管铁替代疗法适用于由绝对缺铁引起的贫血患者，但对于非贫血合并心力衰竭的患者，是否以及如何治疗绝对缺铁或功能性缺铁尚不清楚。最近，一些小规模研究发现，在心力衰竭和绝对或功能性铁缺乏症伴或不伴贫血的患者中，静脉补铁可以改善症状和运动能力，但长期疗效和安全性数据尚不清楚。在这篇综述中，我们讨论了心力衰竭患者贫血和缺铁的原因、发病机制和治疗选择。
Anemia and iron deficiency are important and common comorbidities that often coexist in patients with heart failure. Both conditions, together or independently, are associated with poor clinical status and worse outcomes. Whether anemia and iron deficiency are just markers of heart failure severity or whether they mediate heart failure progression and outcomes and therefore should be treated is not entirely clear. Treatment of anemia in patients with heart failure with erythropoiesis-stimulating agents has been evaluated intensively during the past several years. Unfortunately, these agents did not improve outcomes but were associated with a higher risk of adverse events. Iron deficiency in patients with heart failure can be absolute, when total body iron is decreased, or functional, when total body iron is normal or increased but is inadequate to meet the needs of target tissues because of sequestration in the storage pool. Whereas iron replacement is appropriate in patients with anemia resulting from absolute iron deficiency, it has been unclear whether and how absolute or functional iron deficiency should be treated in nonanemic patients with heart failure. Recently, small studies found that administration of intravenous iron in patients with heart failure and absolute or functional iron deficiency with or without anemia improves symptoms and exercise capacity, but long-term outcomes and safety data are not yet available. In this review, we discuss the causes and pathogenesis of and treatment options for anemia and iron deficiency in patients with heart failure.