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Tissue Doppler and strain rate imaging detect improvement of myocardial function in iron deficient patients with
Rania Gaber1, Nesreen A Kotb, Medhat Ghazy
1Departments of Cardiology Department of Internal Medicine Department of Clinical Pathology, Tanta University, Tanta, Egypt.
Insights
Correcting iron deficiency in patients with heart failure significantly improves exercise capacity and heart function, even without anemia. This study highlights the benefits of iron therapy for improved quality of life in these patients.
Area of Science:
- Cardiology
- Heart Failure Research
- Iron Metabolism
Background:
- Iron deficiency can impair exercise tolerance in congestive heart failure (CHF) patients, independent of anemia.
- Understanding the impact of iron repletion on CHF patients with iron deficiency is crucial for improving outcomes.
Purpose of the Study:
- To assess the effect of correcting iron deficiency on functional capacity in patients with CHF.
- To evaluate the impact of iron repletion on myocardial function in patients suffering from CHF.
Main Methods:
- 40 CHF patients with preserved hemoglobin but low iron levels received intravenous iron dextran.
- Iron therapy continued until ferritin levels reached 200–300 ug/L or transferrin saturation reached 30–40%.
- Functional capacity (6-minute walk test) and myocardial function (echocardiography, tissue Doppler, strain rate) were assessed pre- and post-therapy.
Main Results:
- Significant improvements were observed in New York Heart Association functional class and 6-minute walk distance.
- Myocardial function showed significant enhancement in S'-wave, E/E' ratio, and peak systolic strain rate.
- Ejection fraction did not show a significant change, but diastolic and systolic function improved.
Conclusions:
- Correction of iron deficiency enhances functional class and walking distance in non-anemic systolic heart failure patients.
- Iron therapy improves diastolic and systolic function, as evidenced by Tissue Doppler and strain rate, despite no change in ejection fraction.
- This study supports iron repletion as a therapeutic strategy for improving exercise tolerance and cardiac function in iron-deficient heart failure patients.
Background:
Iron deficiency may contribute to diminished exercise tolerance in patients with congestive heart failure (CHF) even in absence of anemia. The aim of this study was to evaluate the effect of correction of iron deficiency on functional capacity and myocardial function in patients with CHF.
Methods:
We studied 40 patients with ejection fraction <40%, hemoglobin% >12 g/dL, serum ferritin <100 ug/L, and transferrin saturation <20%. Patients received 200 mg weekly doses of iron dextran complex until serum ferritin level was between 200 and 300 ug/L or transferrin saturation level was between 30% and 40%. Transthoracic echocardiogram, tissue Doppler imaging, peak systolic strain rate, and 6 minute walk test were performed before iron therapy and at 12-week follow up. Peak early diastolic myocardial tissue velocity (E'), peak late diastolic myocardial tissue velocity (A'), and peak systolic myocardial tissue velocity (S') were measured.
Results:
There was a significant improvement of New York Heart Association functional class (3.0 ± 0.4 vs. 2.1 ± 0.3, P < 0.05) and 6minutes walk distance (322 ± 104 vs. 377 ± 76, P < 0.01) from rest to follow up, respectively. Ejection fraction did not change significantly (32 ± 8% vs. 34 ± 9%, respectively). There was a significant improvement of S'-wave (3.0 ± 0.8 cm/sec vs. 6.0 ± 1.2 cm/sec, P < 0.05), E/E' ratio (22 ± 3 vs. 13 ± 3, P < 0.05), and peak systolic strain rate (-0.72 ± 0.11/s vs. -1.09 ± 0.37/s, P < 0.05) from baseline to follow-up, respectively.
Conclusion:
Correction of iron deficiency improves functional class and walking distance in nonanemic iron deficient patients with systolic heart failure. Tissue Doppler and strain rate demonstrated a significant improvement of diastolic and systolic function after therapy despite lack of improvement of ejection fraction. (Echocardiography 2012;29:13-18).
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