{"id":"add663de3c0f","type":"article","url":"https://hartvaat.nl/2026/03/19/welke-ijzermarker-voorspelt-de-prognose-bij-nieuw-hartfalen-lage-transferrinesat/","title":"Welke ijzermarker voorspelt de prognose bij nieuw hartfalen? Lage transferrinesaturatie wijst op meer events","title_en":"Biomarkers of iron deficiency and prognosis in patients hospitalised with new-onset heart failure and a reduced left ventricular ejection fraction","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","hfpef","hfref","ijzertekort","nt-probnp","step-hfpef","vrouwen"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003898?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003898?rss=1","authors":["Johansson","J. S. M.","Henrysson","J.","Basic","C.","Cleland","J. G. F.","Fu","M.","Ljungman","C."],"significance":6,"published":"2026-03-19","source_date":"2026-03-19","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/ecg-linkerventrikelhypertrofie/","https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"Iron deficiency is common in heart failure (HF) and is defined in guidelines by ferritin and transferrin saturation (TSAT), not soluble transferrin receptor (sTfR) or its ratios. In this study (325 patients hospitalised with new-onset HFrEF, Sahlgrenska, 2016-2020), the prognostic value of these iron markers was examined; 52% had iron deficiency by current criteria. In the prespecified analysis, markers were not significantly associated with the composite endpoint (HF rehospitalisation or death), although each standard-deviation higher TSAT was associated with 56% less HF rehospitalisation, as were higher iron/sTfR and TSAT/sTfR ratios. In a sensitivity analysis excluding extreme values, higher TSAT was associated with 47% fewer events. Lower TSAT thus predicts more events in new-onset HF; the sTfR ratios offer no clear advantage over TSAT alone.","created":"2026-07-03T10:32:22Z","updated":"2026-07-03T18:39:23Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IJzergebrek komt veel voor bij hartfalen (HF) en wordt in de richtlijnen gedefinieerd op basis van ferritine en transferrinesaturatie (TSAT), niet op de oplosbare transferrinereceptor (sTfR) of ratio's daarvan. In deze studie (325 patiënten opgenomen met nieuw ontstaan HFrEF, Sahlgrenska, 2016-2020) werd de prognostische waarde van deze ijzermarkers onderzocht; 52% had ijzergebrek volgens de huidige criteria. In de vooraf vastgelegde analyse waren de markers niet significant geassocieerd met het samengestelde eindpunt (heropname voor HF of sterfte), al ging elke standaarddeviatie hogere TSAT gepaard met 56% minder HF-heropname, net als hogere ijzer/sTfR- en TSAT/sTfR-ratio's. In een sensitiviteitsanalyse zonder extreme waarden hing een hogere TSAT samen met 47% minder events. Een lage TSAT voorspelt dus meer events bij nieuw hartfalen; de sTfR-ratio's bieden geen duidelijke meerwaarde boven TSAT alleen.","abstract_original":"<sec><st>Background</st>\n<p>Iron deficiency (ID) is common in patients with heart failure (HF). Current guidelines define ID based on serum ferritin and transferrin saturation (TSAT) rather than soluble transferrin receptor (STFR) or ratios such as iron/STFR or TSAT/STFR. We investigated the associations between these biomarkers and prognosis in patients with new-onset HF with reduced ejection fraction (HFrEF).</p>\n</sec>\n<sec><st>Methods</st>\n<p>All patients hospitalised in 2016&ndash;2020 at Sahlgrenska University Hospital with new-onset HFrEF who had iron biomarkers measured within 6 months of discharge were included, with follow-up from the date of the iron biomarker test until 31 December 2021. The primary composite event of interest was first re-hospitalisation for HF (HHF) or all-cause mortality. The associations between ID biomarkers and endpoints were analysed using Cox regression adjusted for age, sex, previous HF, left ventricular ejection fraction, HF medications and comorbidity. Bonferroni-Holm correction was applied for multiple testing.</p>\n</sec>\n<sec><st>Results</st>\n<p>Of 325 patients included (median age 68 (57&ndash;76) years, 70.2% men), 168 (52%) had ID using current guideline criteria and STFR was available for 224 (69%) patients. Median follow-up was 2.2 years. In the prespecified analysis plan, biomarkers of ID were not statistically significantly associated with the primary composite endpoint, although each SD increase in TSAT was associated with 56% lower risk of HHF (0.44 [0.27&ndash;0.71]) as were increased ratios of iron/STFR (0.58 [0.40&ndash;0.86]) and TSAT/STFR (0.55 [0.37&ndash;0.83]). However, in a post hoc sensitivity analysis in which patients with extreme values were excluded, each increase in SD of TSAT was associated with 47% lower risk of the primary composite endpoint (0.53 [0.35&ndash;0.79]).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>Lower TSAT is associated with a greater risk of clinical events in patients with new-onset HF, as were the ratios of iron/STFR and TSAT/STFR. However, neither ratio appeared to offer a substantial advantage compared with TSAT alone.</p>\n</sec>"}