Iron and Heart Failure: Diagnosis, Therapies, and Future Directions

Kambiz Ghafourian, Jason S. Shapiro, Lauren Goodman, Hossein Ardehali*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

14 Scopus citations


To date, 3 clinical trials have shown symptomatic benefit from the use of intravenous (IV) iron in patients with heart failure (HF) with low serum iron. This has led to recommendations in support of the use of IV iron in this population. However, the systemic and cellular mechanisms of iron homeostasis in cardiomyocyte health and disease are distinct, complex, and poorly understood. Iron metabolism in HF appears dysregulated, but it is still unclear whether the changes are maladaptive and pathologic or compensatory and protective for the cardiomyocytes. The serum markers of iron deficiency in HF do not accurately reflect cellular and mitochondrial iron levels, and the current definition based on the ferritin and transferrin saturation values is broad and inclusive of patients who do not need IV iron. This is particularly relevant in view of the potential risks that are associated with the use of IV iron. Reliable markers of cellular iron status may differentiate subgroups of HF patients who would benefit from cellular and mitochondrial iron chelation rather than IV iron.

Original languageEnglish (US)
Pages (from-to)300-313
Number of pages14
JournalJACC: Basic to Translational Science
Issue number3
StatePublished - Mar 2020


  • heart failure
  • intravenous iron
  • iron chelation
  • iron deficiency

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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