Iron deficiency may increase risk of severe HF and adverse events among children with dilated cardiomyopathy

The study showed that in clinical practice, iron studies are under-measured, but iron deficiency is associated with severe heart failure and an increased risk of composite adverse events (CAE). The researchers suggested considering the need for iron replacement therapy in children who present with heart failure with DCM."

"The study is the largest to date to evaluate iron status in pediatric DCM," the researchers reported. "Almost two-thirds of patients who had iron studies measured were iron deficient, and this conferred an increased risk of the composite occurrence of mechanical circulatory support (MCS), death, or transplantation over time."

They added, "Those who were iron deficient had a longer hospital stay and were more likely to be microcytic, anaemic, and hypochromic, with a higher NT-proBNP."

Jack C. Luxford from Children’s Hospital at Westmead, Sydney, Australia, and colleagues aimed to determine the prevalence and impact of iron deficiency in children with dilated cardiomyopathy by conducting a retrospective single-centre cohort study.

For this purpose, the researchers conducted a retrospective single-centre review of all children between 2010 and 2020 with a DCM diagnosis and complete iron studies. Iron deficiency was defined as ≥2 of ferritin <20 μg/litre, transferrin >3 g/liter, iron <9 μmol/litre, or transferrin saturation (TSat) <15%. Laboratory and clinical and freedom from a composite adverse event of MCS, death, or transplant were compared between children with and without ID.

The study led to the following findings:

• Of 138 patients with DCM, 47 had available iron studies. 62% of patients were iron deficient.
• Children with ID were more likely to be receiving inotropes (17, 59%) or invasive/noninvasive ventilation (13, 45%) than those who were iron-replete.
• They had a higher incidence of anaemia (22, 76%) and higher NT-proBNP (1,590 pmol/litre).
• Children with ID had significantly less freedom from the CAE at 1 year (54% ± 10%), 2 years (45 ± 10), and 5 years (37% ± 11%) than those without.
• Iron deficiency and anaemia were the only significant predictors of the CAE on univariate Cox regression.

The findings revealed a high prevalence of ID in children with DCM.

"Iron studies are undermeasured in clinical practice, but ID is associated with severe heart failure and an increased CAE risk," the researchers concluded. "The need for iron replacement therapy should be considered in children who present in HF with DCM."

Reference:

Luxford, J. C., Casey, C. E., Roberts, P. A., & Irving, C. A. (2023). Iron deficiency and anemia in pediatric dilated cardiomyopathy are associated with clinical, biochemical, and hematological markers of severe disease and adverse outcomes. The Journal of Heart and Lung Transplantation. https://doi.org/10.1016/j.healun.2023.11.014