Association between iron metabolism levels and major adverse cardiovascular events in elderly heart failure patients with different ejection fractions
ZHANG Aihua
YOU Hongshuai
WANG Lichao
WU Xingxin
LIU Jiaxin
GAO Shan
REN Chunqi
Abstract：Objective To investigate the association between the changes of iron metabolism levels and occurrence of major adverse cardiovascular events(MACE)in elderly heart failure patients with different ejection fractions.Methods A total of 181 elderly patients with heart failure(HF)were enrolled from the Department of Cardiology of Shunyi District Hospital of Beijing from July 2023 to Apr.2025.According to the examination results of left ventricular ejection fraction(LVEF),the patients were divided into 3 groups:heart failure with preserved ejection fraction(HFpEF)group(HFpEF group,LVEF≥50.0%,n=65),heart failure with mildly reduced ejection fraction(HFmrEF)group(HFmrEF group,LVEF 40%～50%,n=54),and heart failure with reduced ejection fraction(HFrEF)group(HFrEF group,LVEF≤40.0%,n=62).In addition,70 healthy subjects were selected as control group who underwent physical examination in Shunyi District Hospital of Beijing during the same period.The levels of iron metabolism indicators were compared among all groups.All patients were followed up for 3 months after discharge,and were further divided into MACE group(n=46)and the non-MACE group(n=135)according to the occurrence of MACE.The risk factors associated with MACE were analyzed by applying Logistic regression model,and the predictive efficacy of iron metabolism-related indicators for MACE was evaluated by using receiver operating characteristic(ROC)curve.Results Compared with control group,the serum iron,serum ferritin,total iron-binding capacity and transferrin saturation decreased in turn in HFpEF,HFmrEF and HFrEF groups(P<0.050).Among them,HFrEF group had the most significant decrease,followed by HFmrEF group and HFpEF group(P<0.050).After 3 months of follow-up,46 of 181 patients experienced MACE,and 135 did not.The levels of LVEF,serum iron,serum ferritin,total iron-binding capacity and transferrin saturation were significantly lower in MACE group than those in non-MACE group(P<0.050).The results of multivariate Logistic regression analysis showed that LVEF,serum iron,serum ferritin,total iron-binding capacity and transferrin saturation were risk factors for MACE in elderly HF patients(P<0.050).The results of ROC curve analysis revealed that the area under the curve(AUC),sensitivity and specificity of the combined prediction of serum iron,serum ferritin,total iron-binding capacity and transferrin saturation were higher than those of a single indicator,and the combined predictive efficacy of these 4 indicators was better(P<0.050).Conclusion The levels of serum iron,serum ferritin,total iron-binding capacity and transferrin saturation are the lowest,and are risk factors for MACE occurrence in elderly HF patients,and the combination of these 4 indicators has a higher predictive value to MACE occurrence.
Keywords：left ventricular ejection fractionelderlyheart failureiron metabolismadverse cardiovascular events
Publication Date：2026-02-20
Online Publishing Date：2026-03-19(First online date of this platform, not the publication date of the document)
Pages：6( 204-209 )