Iron deficiency (Fedef) might be associated with several markers of poor outcome in pulmonary arterial hypertension (PAH), as concluded in recent meta-analysis published in Heart, Lung and Circulation.

“Fedef in patients with PAH warrants further scrutiny and merits consideration as a cause of clinical deterioration,” the study’s authors said. “Even though causation and longitudinal relationships between Fedef and PAH could not be identified, effect of Fedef on factors that affect disease prognosis is noteworthy and worthy of more focused studies.”

Almost one-half (47%) of the patients included in the study had Fedef, which was associated with cardiovascular dysfunction and reduced functional capacity. More precisely, patients in the Fedef group had lower tricuspid annular plane systolic excursion, increased N-terminal pro-brain natriuretic peptide, and lower mixed venous oxygen saturation, as well as shorter 6-minute walk distance and higher World Health Organization functional class. The inverse correlation between iron stores and World Health Organization functional class was observed even in the absence of overt anemia.

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On the other hand, right atrial pressures and cardiac indices on right heart catherization were similar between patients with Fedef and patients with normal iron stores.

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Oral iron supplementation increased ferritin levels and improved patients’ functional capacity. Moreover, intravenous iron supplementation allowed for an improvement in all iron parameters and exercise capacity.

The meta-analysis included 9 studies with a total of 670 patients with PAH. Four studies reported patient outcomes after iron supplementation.

The authors pointed out several limitations of the study, including the moderate heterogeneity in the results and the use of different definitions for Fedef across different studies.


Saluja P, Gautam N, Amisha FNU, et al. Influence of iron deficiency on clinical and haemodynamic parameters in pulmonary arterial hypertension cohorts. Hear Lung Circ. Published online November 16, 2022. doi: