The association of iron deficiency with right ventricular dysfunction in Africans with heart failure

Background: Iron deficiency (ID) is one of the common comorbidities in heart failure (HF) and is associated with poor morbidity and mortality, especially in Africans. It occurs along the full spectrum of HF phenotypes and is significantly related to left ventricular systolic function. Right ventricular dysfunction (RVD) is often associated with poorer prognosis and mortality. The association of ID and RVD in Africans with HF has not been well explored. We aimed to describe the relationship, if any between iron status and related parameters with right ventricular dysfunction in Africans with HF.Methods: 140 subjects with HF were recruited consecutively from LAUTECH and Bowen Universities Teaching Hospitals, Ogbomoso, Nigeria. Full iron parameters were done for all participants. SPSS 25.0 was used for statistical analysis. ID was defined according to standardized criteria. RVD was determined using the tricuspid annular systolic pulmonary excursion (TAPSE) <20 mm. A p-value<0.05 was taken as statistically significant.Results: The mean age of the study participants is 63.0±16.3 years. The mean body mass index was 24.7±6.5 kg/m2, while 42.9% were males. Anaemia was present in 106 (75.7%) of the study. RVD was present in 76 (54.3%) of the study participants, and it was commoner among those with ID (69.0%) compared to those with normal iron status (32.1%), p<0.001. Mean TAPSE was significantly lower among HF with ID compared with those without ID, 14.4±3.8 vs 16.6±4.52 mm, respectively; p<0.05. Pulmonary hypertension was commoner among HF with ID compared to those with normal iron parameters (33.3% vs 25.9%, respectively; p=0.048). In logistic regression analysis, serum ferritin, transferrin, and left atrial dimension were the major determinants of RVD in the study population.Conclusions: ID is associated with RVD among Africans with HF. The prognostic implication and the potential reversibility of iron replacement therapy need further scrutiny. Identifying those with ID is congruent with increased risk of RVD in HF. Routine iron studies may be essential for future cardiovascular screening in Africans with heart failure and prevention of right ventricular dysfunction.