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1、REVIEWSAnemiaandirondeficiencyinheartfailure:mechanismsandtherapeuticapproachesDirkJ.vanVeldhuisen,StefanD.Anker,PiotrPonikowskiandIainC.MacdougallAbstract
2、Anemiaandirondeficiencyarecommoninpatientswithheartfailure(HF),andareassociatedwithworsesymptomsandadverseo
3、utcomesinthispopulation.Althoughthetwocanoccurtogether,anemiainHFisoftennotcausedbyirondeficiency,andirondeficiencycanbepresentwithoutcausinganemia.Erythropoiesis-stimulatingagentshavebeeninvestigatedextensivelyinthepastfewyearsandmightbeofbenefitinpatientswithHF
4、andanemia.However,concernshavearisenregardingthesafetyoferythropoiesis-stimulatingagentsinpatientswithchronickidneydiseaseandsotheresultsofalargemortalitytrialareeagerlyawaitedtoprovideinformationonsafetyinpatientswithHF.Ironsupplementationorreplacementisamuchold
5、ertreatmentoptionforpatientswithHFandanemia,butquestionsaboutthesafetyofintravenousiron,andabsorptionproblemswithoralformulationshavepreventeditswidespreadusetodate.Inthepastfewyears,however,newdataontheimportanceofirondeficiencyinHFhavebecomeavailable,andanumber
6、ofstudieswithintravenousironhaveshownpromisingresults.Therefore,thistreatmentapproachislikelytobecomeanattractiveoptionforpatientswithHFandirondeficiency,bothwithandwithoutanemia.vanVeldhuisen,D. J.etal.Nat.Rev.Cardiol.8,485–493(2011);publishedonline31May2011;doi
7、:10.1038/nrcardio.2011.77IntroductionAnemiaiscommoninpatientswithheartfailure(HF)andhemoglobinvalues,oraU-shapedrelationship,havebeenitsprevalenceincreaseswiththeseverityofthedisease.1–5reportedinafewstudies.11,12TheWHOhasdefinedanemiaasahemoglobinlevelofManyfact
8、orsinHFmightcontributetothedevelop-<12g/dl(7.5mmol/l)inwomenand<13g/dl(<8.1mmol/l)mentofanemia;1,3,13therefore,thesearchfortheunder-inmen,althoughothercriteriaarealsoused.Accordinglyingmechanismisdifficult.Often,morethanoneetiologytotheWHOcriteria,largeregistries
9、ormeta-analysesisinvolved.Importantfactorsarerenaldysfunction,14–16havedemonstratedthatanemiaispresentin22–37%ofhemodilution,15–17theuseofdrugsgenerallyusedfor
