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Iron deficiency: an emerging therapeutic target in heart failure
  1. Alain Cohen-Solal1,
  2. Christophe Leclercq2,
  3. Gilbert Deray3,
  4. Sigismond Lasocki4,
  5. Jean-Jacques Zambrowski5,
  6. Alexandre Mebazaa6,
  7. Pascal de Groote7,
  8. Thibaud Damy8,
  9. Michel Galinier9
  1. 1Department of Cardiology, Lariboisière Hospital, AP-HP, Paris, France
  2. 2Department of Cardiology and Vascular Disease, Pontchaillou Hospital, Rennes, France
  3. 3Department of Nephrology, Pitié-Salpêtrière Hospital, Paris, France
  4. 4Department of Anesthesia and Critical Care Medicine, CHU Angers, Angers, France
  5. 5Department of Internal Medicine, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
  6. 6Department of Anesthesia and Critical Care Medicine, Lariboisière Hospital, AP-HP, Paris, France
  7. 7Pôle Cardiologie et Médecine Vasculaire, Hôpital Cardiologique, CHRU Lille, Lille, France
  8. 8Department of Cardiology, Henri-Mondor Hospital, AP-HP, Créteil, France
  9. 9Department of Cardiology, CHU Rangueil, Toulouse, France
  1. Correspondence to Professor Alain Cohen-Solal, Department of Cardiology, Lariboisière Hospital, UMR-S 942, DHU FIRE, Paris Diderot University, Assistance Publique—Hôpitaux de Paris, Paris 75010, France; alain.cohen-solal{at}


In patients with heart failure, iron deficiency is frequent but overlooked, with a prevalence of 30%–50%. Since it contributes to cardiac and peripheral muscle dysfunction, iron deficiency is associated with poorer clinical outcomes and a greater risk of death, independent of haemoglobin level. Therefore, iron deficiency emerges as a new comorbidity and a therapeutic target of chronic heart failure in addition to chronic renal insufficiency, anaemia and diabetes. In a series of placebo-controlled, randomised studies in patients with heart failure and iron deficiency, intravenous iron had a favourable effect on exercise capacity, functional class, LVEF, renal function and quality of life. These clinical studies were performed in the context of a renewed interest in iron metabolism. During the past 10 years, knowledge about the transport, storage and homeostasis of iron has improved dramatically, and new molecules involved in iron metabolism have been described (eg, hepcidin, ferroportin, divalent metal transporter 1). Recent European guidelines recommend the monitoring of iron parameters (ie, serum ferritin, transferrin saturation) for all patients with heart failure. Ongoing clinical trials will explore the benefits of iron deficiency correction on various heart failure parameters.

  • Heart Failure

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