ИСТИНА

Purpose This study aimed to investigate the characteristics and prognosis of heart failure patients with ID based on two ID diagnostic criteria: the European Society of Cardiology (ESC) criteria and an alternative definition involving transferrin saturation (TSAT) ≤ 19.8% or Fe ≤ 13 µg/L, showing high sensitivity and specificity for the diagnosis of ID, when compared with bone marrow morphology. Methods We conducted a secondary analysis of a multicenter registry that included 498 HF patients (median EF 45,0, 97% hospitalized), with prognosis data available for 429 of them. We classified patients into four groups: those without ID, those with ID based on ESC criteria (defined as serum ferritin < 100 µg/L, or serum ferritin between 100-300 µg/L with TSAT ≤ 20%), those with ID defined by low TSAT or Fe, and those with ID based on both criteria. The median follow-up period was 2.8 years. Results ID was diagnosed in 83.1% of patients by the ESC criteria and 74.5% by the TSAT ≤ 19.8% or Fe ≤ 13 µg/L criteria. In total, 89.2% of patients had ID diagnosed by at least one criterion, and 68.5% had ID according to both criteria. Patients with ID diagnosed only by the TSAT ≤ 19.8% and Fe ≤ 13 µg/L criteria or both criteria (low TSAT or Fe and ESC criteria), compared with patients with ID diagnosed only by ESC criteria, had lower Fe (9.8 µmol/L and 7.30 µmol/L vs. 19.4 µmol/L), a higher incidence of anemia (43.3% and 47.8% vs. 23.3%), and higher NT-pro BNP levels (2317 and 4182 vs. 1691). The most severe course and the worst prognosis were observed in patients in whom ID was determined according to both criteria. In this group, 43.2% of patients died, compared with 27.3% in the ESC-only group, 19.0% in the TSAT ≤ 19.8% or Fe ≤ 13 µg/L-only group, and 23.9% in patients without ID by either criterion (p=0.003). Among patients with ID according to both criteria, there were no statistically significant differences between patients with low TSAT or Fe and ferritin < 100 µg/L and those with low TSAT or Fe and ferritin ≥ 100 µg/L. Conclusion Heart failure patients with ID identified by both ESC and alternative criteria (low TSAT or Fe) had the most severe symptoms and the worst prognosis, with a significantly higher mortality rate. The prognosis for patients with ID diagnosed solely by ESC criteria or low TSAT/Fe criteria was more favorable. This highlights the importance of considering multiple diagnostic criteria for optimal patient management