Background. Heart failure patients presenting with iron deficiency can benefit from systemic iron supplementation; however, there is the potential for iron overload to occur, which can seriously damage the heart. Therefore, myocardial iron (M-Iron) content should be precisely balanced, especially in already failing hearts. Unfortunately, the assessment of M-Iron via repeated heart biopsies or magnetic resonance imaging is unrealistic, and alternative serum markers must be found. This study is aimed at assessing M-Iron in patients with advanced heart failure (HF) and its association with a range of serum markers of iron metabolism. Methods. Left ventricle (LV) myocardial biopsies and serum samples were collected from 33 consecutive HF patients (25 males) with LV dysfunction (LV ejection fraction 22 (11) %; NT-proBNP 5464 (3308) pg/ml) during heart transplantation. Myocardial ferritin (M-FR) and soluble transferrin receptor (M-sTfR1) were assessed by ELISA, and M-Iron was determined by Instrumental Neutron Activation Analysis in LV biopsies. Nonfailing hearts () were used as control/reference tissue. Concentrations of serum iron-related proteins (FR and sTfR1) were assessed. Results. LV M-Iron load was reduced in all HF patients and negatively associated with M-FR (, ). Of the serum markers, sTfR1/logFR correlated with (; ) and predicted (in a step-wise analysis, ; ) LV M-Iron. LV M-Iron load (μg/g) can be calculated using the following formula: . Conclusions. The sTfR1/logFR ratio can be used to predict LV M-Iron levels. Therefore, serum FR and sTfR1 levels could be used to indirectly assess LV M-Iron, thereby increasing the safety of iron repletion therapy in HF patients.

中文翻译：

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晚期心力衰竭患者心肌铁负荷的准确无创评估

背景。出现缺铁的心力衰竭患者可以从全身补铁中受益；然而，有可能发生铁过载，这会严重损害心脏。因此，心肌铁 (M-Iron) 含量应精确平衡，尤其是在已经衰竭的心脏中。不幸的是，通过重复心脏活检或磁共振成像评估 M-Iron 是不现实的，必须找到替代的血清标志物。本研究旨在评估晚期心力衰竭 (HF) 患者的 M-Iron 及其与一系列铁代谢血清标志物的关联。方法. 左心室 (LV) 心肌活检和血清样本是在心脏移植期间从 33 名患有 LV 功能障碍（LV 射血分数 22 (11) %；NT-proBNP 5464 (3308) pg/ml）的连续 HF 患者（25 名男性）收集的。通过 ELISA 评估心肌铁蛋白 (M-FR) 和可溶性转铁蛋白受体 (M-sTfR1)，并通过 LV 活检中的仪器中子活化分析确定 M-Iron。永不失败的心（)用作对照/参考组织。评估了血清铁相关蛋白（FR 和 sTfR1）的浓度。结果。所有 HF 患者的 LV M-Iron 负荷均降低，并且与 M-FR 呈负相关（, ）。在血清标志物中，sTfR1/logFR 与 (; ）和预测（在逐步分析中，; ) LV M-铁。LV M-铁负荷（ μg /g）可以使用以下公式计算：. 结论。sTfR1/logFR 比率可用于预测 LV M-Iron 水平。因此，血清 FR 和 sTfR1 水平可用于间接评估 LV M-Iron，从而提高 HF 患者补铁治疗的安全性。