Course Peculiarities of Systolic Chronic Heart Failure in Patients with Concomitant Iron Deficiency

Chronic heart failure is characterized by a progressive growth rate in the population and remains an urgent problem of our times. The combination of chronic heart failure with other comorbid states, which can significantly complicate its course, attracts the great attention of the researchers. More and more sources, indicating the high incidence of iron deficiency as a clinico-hematological symptom complex among the patients with cardiovascular diseases, appear. From this perspective, the combination of chronic heart failure and iron deficiency with or without anemia appears to be quite problematic from the practical point of view. Material and methods. This study involved 152 patients with hypertension (HT) with / without ischemic heart disease (IHD) complicated by chronic heart failure (CHF) (NYHA functional class (FС) II-III symptoms). 122 patients had iron deficiency (ID), aged 52-78 (mean 69.6 ± 0.68, median – 70.5). Among them 36 (29.5%) female and 86 (70.5%) male. Patients with systolic CHF and ID formed the main clinical study groups. The remaining 30 patients were the comparison group, which included patients with systolic CHF with no symptoms of ID, aged 48-79 (mean 68.7 ± 1.7, median – 71). There were 6 (20.0%) female and 24 (80.0%) male patients among them. ID criteria: lowering blood serum iron in women < 11.5 μmol/L, < 13.0 μmol/L in men, true ID was associated with a decrease in ferritin < 100 ng/ml and a functional level of ferritin of 100-300 ng/ml with TSAT < 20%. Hb levels were less than130 g/l for men and below 120 g/l for women. A general analysis of the data obtained in the study was carried out in three clinical groups of patients. The first group (n=30) consisted of patients with systolic CHF without ID; the second group (n=60) had patients with latent ID; the third group (n = 62) had patients with systolic CHF and comorbid iron deficiency anemia (IDA). Statistical analysis was done using Microsoft Office Excel 2007. Results and discussion. Groups of patients were matched according to sex, age, body mass index (BMI), clinical characteristics as, stages of HT, myocardial infarction (MI), stages of CHF, and persistent form of atrial fibrillation (AF). Groups of patients with ID, with and without anemia, are associated with a more severe clinical course characterized by a higher NYHA FC of chronic heart failure, progression of angina, diabetes and an uncontrolled course of HT. In the group with systolic CHF and comorbid ADI, the combination of HT and IHD was observed in 38 patients, which was 61.3%, this benefit was statistically compared with the first group (p˂0.05). This group had the incidence of angina pectoris which was significantly more often diagnosed in comparison with patients in the comparative group (31-50.0% vs. 11-36.7%, respectively (p˂0.05). The number of patients with II FC of angina pectoris was prevalent in the first group. There was an advantage III FC of angina pectoris (53.0% and 58.1%) in the second and third clinical groups. There were also a greater number of patients with an uncontrolled course of HT (78.3% and 80.0%), diabetes (46.6% and 48.4%) and significant advantage of the NYHA FC III of chronic heart failure (71.6% and 73.3%) in these clinical groups. Conclusions. The patients with systolic chronic heart failure and iron deficiency with or without anemia are a particular problem for practical healthcare. An adverse impact of anemia on the course of chronic heart failure was proven