Short-Term Impact of Iron Deficiency in Different Subsets of Patients with Precapillary Pulmonary Hypertension from an Eastern European Pulmonary Hypertension Referral Center

Ioan Tilea,1,2 Dorina Nastasia Petra,3,4 Razvan Constantin Serban,5 Manuela Rozalia Gabor,6 Mariana Cornelia Tilinca,1 Leonard Azamfirei,7,8 Andreea Varga2,3 1Department of Internal Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania; 2Department of Cardiology II, County Emergency Clinical Hospital, Targu Mures, 540042, Romania; 3Department of Family Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania; 4Department of Internal Medicine II, County Emergency Clinical Hospital, Targu Mures, 540042, Romania; 5Cardiac Catheterization Laboratory, The Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, 540136, Romania; 6Department of Economics and Law, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania; 7Department of Anesthesiology and Intensive Care, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, Romania; 8Department of Anesthesiology and Intensive Care, County Emergency Clinical Hospital, Targu Mures, 540042, RomaniaCorrespondence: Dorina Nastasia PetraDepartment of Family Medicine, “George Emil Palade” University of Medicine, Pharmacy, Science and Technology of Targu Mures, Targu Mures, 540142, RomaniaTel +40 740 194 122Email dorina.petra@umfst.roBackground: Over the last few decades, interest in the role of iron status in pulmonary hypertension (PH) has grown considerably due to its potential impact on symptoms, exercise capacity (as assessed by the 6-minute walk distance [6MWD]), prognosis, and mortality. The aim of the present study was to identify iron deficiency (ID) prevalence in specific precapillary PH subgroups of Romanian patients and its short-term impact on 6MWD.Patients and Methods: Complete datasets from 25 precapillary PH adults were examined and included in the analysis. Data were collected at baseline and after continuous follow-up of an average of 13.5 months. Enrolled patients were assigned to group 1 (pulmonary arterial hypertension) or subgroup 4.1 (chronic thromboembolic pulmonary hypertension), and individualized targeted therapy was prescribed. General characteristics, World Health Organization functional class, 6MWD, pulse oximetry, laboratory parameters, and echocardiographic and hemodynamic parameters were recorded. Ferritin values and transferrin saturation were used to assess ID.Results: At baseline, 16 out of 25 patients were iron deficient. The univariate linear regression analysis did not show a statistically significant impact of ID on 6MWD (p=0.428). In multivariate regression analysis, possible predictors of 6MWD, including ID, were not statistically significant at baseline or after an average of 13.5 months follow-up (p=0.438, 0.361, respectively) and ID indicates a negative impact on 6MWD independent of applied corrections.Conclusion: The results of this study demonstrate that 1.4.1 subgroup PAH patients have an increased prevalence of ID compared with other etiologies. ID has a negative impact on the functional status (assessed by 6MWD), in specific groups and subgroups of patients with precapillary PH, albeit not independently nor significant to other known predictors such as age, gender, oxygen saturation, and hemoglobin value. These data can be integrated with global research and are consistent with phenotypes of patients diagnosed with PH of different etiologies.Keywords: pulmonary arterial hypertension, chronic thromboembolic pulmonary hypertension, ferritin, iron replenishment, six-minute walk distance