Impact of iron replacement therapy on six minutes walking test (functional state) in patients with heart failure with reduced ejection fraction and iron deficiency
DOI:
https://doi.org/10.15218/zjms.2022.015Keywords:
Iron replacement therapy, Six minute walking test, Heart failure, Ejection fraction, Iron deficiencyAbstract
Background and objective: Iron deficiency may impair aerobic performance. This study aimed to assess whether intravenous iron (ferric carboxymaltose) will improve symptoms in patients with heart failure with reduced left ventricular ejection fraction and iron deficiency or not, depending on serum ferritin or transferrin saturation with or without anemia.
Methods: We enrolled 100 patients with heart failure with reduced ejection fraction (less than 40%) and iron deficiency (serum ferritin less than 100 ng/ml, or between 100-299 ng/ml but transferrin saturation less than 20%). The patient received an intravenous iron supplement of ferric carboxymaltose (1000-2500mg) until the correction of their iron status. We checked the 6-minute walking test, New York Heart Association functional class, and ejection fraction for each patient at baseline, 12 weeks, and 24 weeks after intervention.
Results: Our study showed a significant improvement in the patient's functional status. The 6-minute walking test, New York Heart Association functional class, improved significantly in patients at 12 weeks and continues to improve beyond 24 weeks with or without anemia. The left ventricular ejection fraction in our study was not improved significantly.
Conclusion: Treatment with intravenous iron supplement (ferric carboxymaltose) in patients with chronic stable heart failure and iron deficiency, with or without anemia, improves symptoms, functional capacity, and quality of life.
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References
Gardner W, Kassebaum N. Global, regional, and national prevalence of anemia and its causes in 204 countries and territories, 1990–2019. Current Developments in Nutrition 2020;4(Supplement_2):830. https://doi.org/10.1093/cdn/nzaa053_035
Bui AL, Horwich TB, Fonarow GC. Epidemiology and risk profile of heart failure. Nat Rev Cardiol. 2011;8(1):30–41.https://doi.org/10.1038/nrcardio.2010.165
Fihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, et al. Guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation. 2012;126(25):3097–137. https://doi.org/10.1161/CIR.0b013e3182776f83
Sagar VA, Davies EJ, Briscoe S, Coats AJ, Dalal HM, Lough F, et al. Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart. 2015;2(1):e000163. https://doi.org/10.1136/openhrt-2014-000163
Rishi G, Subramaniam VN. The relationship between systemic iron homeostasis and erythropoiesis. Biosci Rep. 2017;37(6):BSR20170195. https://doi.org/10.1042/BSR20170195
Anker SD, Comin Colet J, Filippatos G, Willenheimer R, Dickstein K, Drexler H, et al. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436–48. https://doi.org/10.1056/NEJMoa0908355
Allen RP, Auerbach S, Bahrain H, Auerbach M, Earley CJ. The prevalence and impact of restless legs syndrome on patients with iron deficiency anemia. Am J Hematol. 2013;88(4):261–4. https://doi.org/10.1002/ajh.23397
Hinton PS. Iron and the endurance athlete. Appl Physiol Nutr Metab. 2014;39(9):1012–8. https://doi.org/10.1139/apnm-2014-0147
Jain S, Bakshi N, Krishnamurti L. Acute chest syndrome in children with sickle cell disease. Pediatr Allergy Immunol Pulmonol. 2017;30(4):191–201. https://doi.org/10.1089/ped.2017.0814
McDonagh T, Macdougall IC. Iron therapy for the treatment of iron deficiency in chronic heart failure: intravenous or oral? Eur J Heart Fail. 2015;17(3):248–62. https://doi.org/10.1002/ejhf.236
Anand IS, Gupta P. Anemia and iron deficiency in heart failure: current concepts and emerging therapies. Circulation. 2018;138(1):80–98. https://doi.org/10.1161/CIRCULATIONAHA.118.030099
Sandek A, Bjarnason I, Volk HD, Crane R, Meddings JB, Niebauer J, et al. Studies on bacterial endotoxin and intestinal absorption function in patients with chronic heart failure. Int J Cardiol. 2012;157(1):80–5. https://doi.org/10.1016/j.ijcard.2010.12.016
Bojarczuk J, Josiak K, Kasztura M, Kustrzycka-Kratochwil D, Nowak K, Jagielski D, et al. Iron deficiency in heart failure: Impact on response to cardiac resynchronization therapy. Int J Cardiol. 2016;222:133–4. https://doi.org/10.1016/j.ijcard.2016.07.280
Van Veldhuisen DJ, Anker SD, Ponikowski P, Macdougall IC. Anemia and iron deficiency in heart failure: mechanisms and therapeutic approaches. Nat Rev Cardiol. 2011;8(9):485–93. https://doi.org/10.1038/nrcardio.2011.77
Klip IT, Comin-Colet J, Voors AA, Ponikowski P, Enjuanes C, Banasiak W, et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J. 2013;165(4):575–82. https://doi.org/10.1016/j.ahj.2013.01.017
Hermida RC, Ayala DE, Mojón A, Fernández JR. Decreasing sleep-time blood pressure determined by ambulatory monitoring reduces cardiovascular risk. J Am Coll Cardiol. 2011;58(11):1165–73. https://doi.org/10.1016/j.jacc.2011.04.043
Cleland JG, Zhang J, Pellicori P, Dicken B, Dierckx R, Shoaib A, et al. Prevalence and outcomes of anemia and hematinic deficiencies in patients with chronic heart failure. JAMA Cardiol. 2016;1(5):539–47. https://doi.org/10.1001/jamacardio.2016.1161
Ebner DB, von Haehling PD. The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. European Journal of Heart Failure. 2015;17:169. https://doi.org/10.1016/j.ijcard.2015.11.178
Jankowska EA, von Haehling S, Anker SD, Macdougall IC, Ponikowski P. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J. 2013;34:816–29. https://doi.org/10.1093/eurheartj/ehs224
Cohen-Solal A, Leclercq C, Deray G, Lasocki S, Zambrowski JJ, Mebazaa A, et al. Galinier M. Iron deficiency: an emerging therapeutic target in heart failure. Heart. 2014;100:1414–20. https://doi.org/10.1136/heartjnl-2014-305669
Longo DL, Camaschella C. Iron-deficiency anemia. N Engl J Med. 2015;372(19):1832–43. https://doi.org/10.1056/NEJMra1401038
Camaschella C. Iron deficiency. Blood. 2019;133(1):30–9. https://doi.org/10.1182/blood-2018-05-815944
Camaschella C. New insights into iron deficiency and iron deficiency anemia. Blood Rev. 2017;31(4):225–33. https://doi.org/10.1016/j.blre.2017.02.004
Goodnough LT, Nemeth E, Ganz T. Detection, evaluation, and management of iron-restricted erythropoiesis. Blood. 2010;116(23):4754–61. https://doi.org/10.1182/blood-2010-05-286260
Grundtvig M, Eriksen Volnes T, Ørn S, Slind EK, Gullestad L. 6 min walk test is a strong independent predictor of death in outpatients with heart failure. ESC Heart Failure. 2020;7(5):2904–11. https://doi.org/10.1002/ehf2.12900
Ferreira JP, Metra M, Anker SD, Dickstein K, Lang CC, Ng L, et al. Clinical correlates and outcome associated with changes in 6 minute walking distance in patients with heart failure: findings from the BIOSTAT-CHF study. Eur J Heart Fail. 2019;21(2):218–26. https://doi.org/10.1002/ejhf.1380
Van Veldhuisen DJ, Ponikowski P, van der Meer P, Metra M, Böhm M, Doletsky A, et al. Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency. Circulation. 2017;136(15):1374–83. https://doi.org/10.1161/CIRCULATIONAHA.117.027497
Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239. https://doi.org/10.1016/j.jacc.2013.05.019
Ponikowski P, Van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015;36(11):657–68. https://doi.org/10.1093/eurheartj/ehu385
Zhou X, Xu W, Xu Y, Qian Z. Iron supplementation improves cardiovascular outcomes in patients with heart failure. Am J Med. 2019;132(8):955–63. https://doi.org/10.1016/j.amjmed.2019.02.018
Caraballo C, Desai NR, Mulder H, Alhanti B, Wilson FP, Fiuzat M, et al. Clinical implications of the New York heart association classification. J Am Heart Assoc. 2019;8(23):e014240. https://doi.org/10.1161/JAHA.119.014240
World Health Organization. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. World Health Organization; 2011.
Brenes-Monge A, Saavedra-Avendaño B, Alcalde-Rabanal J, Darney BG. Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition. BMC Pregnancy Childbirth. 2019;19:239. https://doi.org/10.1186/s12884-019-2393-5
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