Heart muscle weakness More iron makes the heart more resilient

Iron deficiency can aggravate myocardial insufficiency
Iron is an important trace element that should be supplied in sufficient quantities through the daily diet. Scientists at the Hannover Medical School (MHH) have found that iron deficiency has serious consequences in heart failure. But the damaging process seems to be reversible, researchers confirm with new results. Therefore, heart failure patients should be careful not to suffer from deficiency symptoms. The study was published in the "European Heart Journal".

Patients with heart failure (heart failure) often suffer from iron deficiency. When treated with iron, patients feel better, are more resilient, less likely to go to hospital and possibly live longer. Scientists at the Hannover Medical School (MHH) have now discovered why this is so: they described the underlying mechanism and published it in the prestigious journal "European Heart Journal". Not only do they explain the positive effects of iron therapy that doctors and patients have been observing for some time, but also why iron is so important to the function of the heart.

Iron deficiency can be corrected by pills or by a balanced diet. Picture: monropic - fotolia

Iron is a trace element that all living things need to absorb with food. For some years, it has been known that even mild iron deficiency in heart failure is detrimental, even if there is no anemia (anemia). In iron deficiency anemia, not enough red blood cells can be produced to transport the oxygen in the body. Here it is obvious that one gets tired quickly and is physically less resilient.

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"Iron is not only important for the transport of oxygen, but is also needed in the power plants of the cell, the mitochondria. In iron deficiency, the mitochondria can produce less energy. However, the heart muscle in particular is dependent on a high energy input for its pumping function, "explains Professor Dr. med. Tibor Kempf, who works with Professor Kai Wollert has performed. The two scientists of the MHH Clinic for Cardiology and Angiology worked with Dr. med. Bruno Galy and Professor dr. Matthias Hentze from Heidelberg together. The first author of the publication is Saba Haddad, who carried out this study as part of her PhD work with Professor Kempf.

In order to find out how the iron balance in cardiomyocytes is regulated, the researchers switched off so-called Irp proteins in heart muscle cells. "Irp proteins regulate the iron content of the cell. If Irp proteins are inactivated, less iron can be absorbed into the cell. For vital metabolic processes is no longer enough iron available, the mitochondria can then work worse, "explains Professor Wollert.

Mice in which the Irp proteins were switched off developed iron deficiency in the heart, but not in the blood and other organs. Under rest conditions one did not notice the animals, but with physical stress their hearts could not increase the pump function. After a heart attack, the animals developed pronounced heart failure. The cause was too low energy production in the mitochondria. When the MHH researchers administered iron to the mice, they were able to fill up their iron stores in the heart, the heart muscle cells again produced sufficient energy and the heart function normalized.

Heart failure is one of the leading causes of death in Germany and is caused by heart attacks, high blood pressure or heart valve defects. Further results of the MHH researchers show that a reduced activity of Irp proteins also plays a role in patients. "Iron deficiency is therefore not only a sign of a poor prognosis, but also the cause of the poor prognosis of patients with heart failure. And it can easily be remedied, "stresses Professor Dr. Johann Bauersachs, Director of the MHH Clinic for Cardiology and Angiology.

Since the beginning of this year, the new guidelines recommend that doctors prescribe iron to patients with heart failure if they have iron deficiency. Several clinical studies are currently investigating whether iron administration can not only improve symptoms but also prolong patients' lives. (Sb)