The Effects of Ferrous Sulfate as an Iron Supplement on Ejection Fraction in Patients with Iron Deficiency Anemia Associated with Decompensated Heart Failure

Abstract

Background: Acute decompensated heart failure (HF) is a clinical syndrome that results when abnormalities in the structure and functionof the myocardium impair cardiac output or decrease filling of the ventricles. Anemia is a common comorbidity in patients with chronicHF (CHF), is associated with increased disease severity, and may contribute to a worse the outcome. Aim of the Study: To study the relationship between iron level and left ventricular function (LVF) in patients having acute decompensated HF and the effects of iron supplement on thisfunction. Patients and Methods: This cross‑sectional study was conducted in the medical wards of Baghdad Teaching Hospital at differenttimes during the period between October 1, 2016, and May 1, 2017. It included 60 patients diagnosed with CHF (9 patients with HF withpreserved ejection fraction [EF] and 51 patients with HF with reduced EF) and admitted to the medical wards due to acute decompensation.For all patients, history, cardiological examination, New York Heart Association classification, electrocardiogram, and chest X‑ray weredone. Body mass index was measured. Standard echocardiography was performed. Hematological parameters were measured includinghemoglobin (Hb), mean corpuscular volume, mean corpuscular Hb (MCH), MCH concentration, blood film, serum iron, erythrocyte count,total iron‑binding capacity, and transferrin saturation. Results: Serum iron was significantly lower in patients with impaired EF with medianserum iron 41 versus 94 mcg/dL in preserved EF (72.5% vs. 0%). Transferrin saturation was statistically and significantly lower in patientswith EF <50% (39.2% of the patients with impaired EF had low transferrin saturation [P < 0.001] compared to 0% in patients with preservedEF). EF had inverse significant correlation with total binding capacity of iron (r = −0.585, P < 0.001). Iron supplements as ferrous sulfatehave a highly significant effect (P < 0.001) on improving the LVF and EF, iron level and transferrin saturation in patients with decompensatedHF with low EF. Conclusions: Most HF patients with low EF in this study had reduced iron level and transferrin saturation comparing tothose with preserved EF. Iron supplement in a patient with low EF preserved the EF in them. Anemia still is founded in patients of HF withacceptable EF in the presence of normal iron status, and this is explained by other causes rather than iron deficiency