Patients referred for transcatheter aortic valve implantation (TAVI) are typically
elderly with several co-morbidities, which might limit prognosis despite successful
procedural outcome. To date, the prevalence and clinical impact of iron deficiency
(ID) in patients with severe aortic stenosis who underwent TAVI remains poorly defined.
This study included 495 patients who underwent transfemoral TAVI for severe symptomatic
aortic stenosis. ID was defined as ferritin <100 ng/ml or ferritin 100 to 300 ng/ml,
when transferrin saturation was <20%. The primary end point of the study was a composite
of all-cause mortality, unplanned readmission for worsening heart failure or red blood
cell transfusions during the first year after TAVI, which occurred in 22% (109 of
495) of the population. ID was present in 54% (268 of 495) of the entire cohort and
was associated with a higher rate of the primary end point (27.6% [74 of 268] vs 15.4%
[35 of 227]; p = 0.001). After multivariable adjustment, the association of ID with
the primary end point remained significant (hazard ratio 1.64, 95% confidence interval
[1.08 to 2.48]; p = 0.019). In a subgroup of ferropenic patients (n = 56), treatment
with intravenous iron before TAVI was feasible, resulting in a considerable improvement
of ferritin, transferrin saturation and symptoms at 30-day follow-up. In conclusion,
ID is common in TAVI patients and is associated with adverse clinical outcome after
TAVI. Correction of ID with intravenous iron seems feasible in contemporary TAVI patients.
Whether this reduces transfusion rates and impacts clinical outcome after TAVI remains
to be investigated in future prospective trials.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 18,
2019
Received:
April 22,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
