Alnuwaysir, R. (Ridha) (2021) Beyond the cardiorenal anaemia syndrome: A comprehensive analysis of the additive burden of iron deficiency in heart failure patients. thesis, Medicine.
Full text available on request.Abstract
Introduction Heart failure(HF) patients with the so-called cardiorenal-anaemia syndrome (CRAS) are at greater risk of both morbidity and mortality. Iron deficiency (ID) in HF patients is associated with reduced quality of life, exercise tolerance and worse prognosis, independently of anaemia. The contributory role of iron deficiency beyond this complex interplay of CRAS has not yet been studied comprehensively. Methods We have studied 2153 HF patients from the BIOSTAT-CHF cohort. The minimax concave algorithm was used to identify commonalities and differences between ID-alone, iron deficiency anaemia (IDA), CRAS, cardiorenal iron deficiency syndrome (CRIDS) and cardiorenal-anaemia-iron deficiency syndrome (CRAIDS) in terms of their clinical and biomarker determinants. Subsequently, enrichment analysis was conducted to establish common and unique pathways among the studied comorbidities. Additionally, the prognostic value of ID beyond CRAS was investigated using Kaplan Meier curves and Cox proportional hazard models Results From the total cohort of 2151 patients, most patients had only ID (20%), while only 17% had CRAIDS. There was no common clinical predictor between the five syndromes. Also, multiple discriminatory biomarker profiles were found with minimal overlap between the studied conditions. Enrichment analysis revealed that pathways related to immunity, inflammation, blood vessel morphogenesis and cancer are amongst the most overlapping pathways, while IL-4, IL-13 and IL-8 signalling are amongst the unique pathways. Survival analysis showed that concomitant anaemia and/or CKD with ID is associated with worse prognosis, while ID-alone is an independent predictor of negative outcomes only in those with absolute iron deficiency (hazard ratio 1.20; 95% confidence interval: 1.01 to 1.42). Conclusion The simultaneous existence of CKD, anaemia and/or ID in HF form pathophysiologically distinct entities with substantial impact on mortality and morbidity. Our results provide supporting evidence that even pure iron deficiency could have negative impacts on heart failure patients. In addition, this research provides new theoretical insights into the pathogenic mechanisms of the studied syndromes that could be further explored as potential therapeutic targets in HF.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Markousis‐Mavrogenis, G. and Meer, prof. dr. P. van der |
| Faculty: | Medical Sciences |
| Date Deposited: | 03 Jan 2022 10:36 |
| Last Modified: | 03 Jan 2022 10:36 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2919 |
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