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Original research article
Prevalence and prognostic implication of iron deficiency and anaemia in patients with severe aortic stenosis
  1. Anette Borger Kvaslerud1,2,
  2. Amjad Iqbal Hussain1,3,
  3. Andreas Auensen1,2,
  4. Thor Ueland4,5,
  5. Annika E Michelsen1,4,
  6. Kjell Ingar Pettersen3,
  7. Pål Aukrust1,6,
  8. Lars Mørkrid1,7,
  9. Lars Gullestad1,2,3 and
  10. Kaspar Broch2,3
  1. 1Faculty of Medicine, University of Oslo, Oslo, Norway
  2. 2KG Jebsen Centre for Cardiac Research and Center for Heart Failure Research, Oslo University Hospital Ullevål, Oslo, Norway
  3. 3Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
  4. 4Research Institute for Internal Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
  5. 5K.G. Jebsen - Thrombosis Research and Expertise Center (TREC), The Faculty of Health Sciences, UT – The Arctic University of Norway, Tromsø, Norway
  6. 6Section of Clinical Immunology and Infectious Diseases, Oslo University Hospital, Rikshospitalet, Oslo, Norway
  7. 7Department of Medical Biochemistry, Oslo University Hospital Rikshospitalet, Oslo, Norway
  1. Correspondence to Dr Anette Borger Kvaslerud; a.b.kvaslerud{at}


Objective The aim of this study was to evaluate the prevalence and prognostic implication of iron deficiency (ID) and anaemia in patients with severe aortic stenosis (AS).

Methods In an observational study of consecutive patients referred for aortic valve replacement (AVR), we assessed a wide range of biomarkers of iron status, including the definition of ID commonly applied in patients with chronic heart failure (ferritin <100 µg/L or ferritin 100–299 µg/L with a transferrin saturation <20%). The endpoints were short-term (one-year) and long-term (median 4.7 years, IQR: 3.8–5.5) mortality and major adverse cardiovascular events (MACE) within the first year after inclusion.

Results 464 patients were included in this substudy. 91 patients (20%) received conservative treatment and 373 patients (80%) received AVR. ID was detected in 246 patients (53%). 94 patients (20%) had anaemia. Patients with ID had an overall worse clinical profile than patients without ID. During follow-up, 129 patients (28%) died. Neither ID as defined above, soluble transferrin receptor nor hepcidin were associated with short-term or long-term mortality or MACE independent on treatment allocation. Anaemia was associated with one-year mortality in conservatively treated patients.

Conclusions ID and anaemia are prevalent in patients with severe AS. In our cohort, ID did not provide independent prognostic information on top of conventional risk factors. More studies are required to determine how to correctly diagnose ID in patients with AS.

Trial registration number NCT01794832.

  • aortic valve disease
  • epidemiology
  • prosthetic heart valves
  • iron deficiency
  • anaemia

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  • Presented at Preliminary results from this study have been presented as a poster presentation at the ESC Heart Failure Congress in Vienna in May 2018 prior to submission.

  • Contributors LG, KB, LM, AA, AIH, PA and ABK conceived and designed the analysis. AA, AIH, LG, KIP, LM, TU, AEM and ABK collected the data. ABK and KB analysed the data. ABK wrote the manuscript with support from KB. All authors revised the work critically, read and approved the final manuscript and agree to be accountable for all aspects of the work. ABK is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.

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