High soluble transferrin receptor in patients with heart failure:a measure of iron deficiency and a strong predictor of mortality

Aims Iron deficiency (ID) is frequent in heart failure (HF), linked with exercise intolerance and poor prognosis. Intravenous iron repletion improves clinical status in HF patients with left ventricular ejection fraction (LVEF)Methods and results Bone marrow was stained for iron in 30 patients with ischaemic HF with LVEF = 1.25 mg/L in 47% of HF patients, in 56% and 46% of anaemics and non-anaemics, respectively (P < 0.05). The reclassification methods revealed that serum sTfR significantly added the prognostic value to the baseline prognostic model, and to the greater extent than plasma N-terminal pro B-type natriuretic peptide. Based on internal derivation and validation procedures, serum sTfR >= 1.41 mg/L was the optimal threshold for predicting 3-year mortality, independent of other established variables.Conclusions High serum sTfR accurately reflects depleted iron stores in bone marrow in patients with HF, and identifies those with a high 3-year mortality.