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Short-term changes in left and right systolic function following ferric carboxymaltose: a substudy of the
Enrique Santas1,2, Gema Miñana1,2, Ingrid Cardells3
1Cardiology Department, Hospital Clínico Universitario de Valencia, Universidad de Valencia, INCLIVA, Valencia, Spain.
Insights
Ferric carboxymaltose (FCM) significantly improved left and right ventricular function in patients with heart failure and iron deficiency. This treatment offers a short-term boost to cardiac performance, particularly for right ventricular function.
Area of Science:
- Cardiology
- Iron Metabolism
- Heart Failure Research
Background:
- The precise mechanisms of ferric carboxymaltose (FCM) benefits in heart failure (HF) with iron deficiency (ID) require further elucidation.
- Previous research has established a link between ID and adverse outcomes in HF patients.
Purpose of the Study:
- To investigate the association between ferric carboxymaltose (FCM) treatment and cardiac magnetic resonance-assessed changes in left and right ventricular function.
- To evaluate these changes in patients with heart failure (HF) and iron deficiency (ID) experiencing varying degrees of systolic dysfunction.
Main Methods:
- A post hoc analysis of the double-blind, randomized Myocardial-IRON trial involving 53 patients with HF and ID.
- Utilized linear mixed regression models to assess changes in left ventricular ejection fraction (LVEF) and right ventricular ejection fraction (RVEF) at 7 and 30 days post-treatment.
- Patients were categorized based on baseline left ventricular systolic dysfunction (LVSD) and right ventricular systolic dysfunction (RVSD) criteria.
Main Results:
- Ferric carboxymaltose (FCM) treatment led to a significant improvement in LVEF at 30 days in patients with LVSD (Δ2.3% to 4.1%, P < 0.014).
- FCM demonstrated a significant and early improvement in RVEF by 7 days (Δ3.2% to 6.9%, P < 0.003), which was sustained at 30 days (Δ4.7% to 8.1%, P < 0.001).
- Improvements were observed across different severity levels of RVSD and LVSD.
Conclusions:
- Ferric carboxymaltose (FCM) is associated with short-term improvements in left ventricular ejection fraction (LVEF) in patients with HF, ID, and systolic dysfunction.
- FCM particularly demonstrated significant and sustained improvements in right ventricular ejection fraction (RVEF) in this patient cohort.
- These findings highlight the potential of FCM in improving cardiac function in HF patients with iron deficiency.
Aims:
The mechanisms underlying the beneficial effect of ferric carboxymaltose (FCM) in patients with heart failure (HF) and iron deficiency (ID) have not been completely characterized. The Myocardial-IRON trial was a double-blind, randomized trial that evaluated myocardial iron repletion following FCM vs. placebo in 53 patients with HF and ID. In this post hoc analysis, we evaluated whether treatment with FCM was associated with cardiac magnetic resonance changes in left and right ventricular function (LVEF and RVEF, respectively) at different points of systolic dysfunction.
Methods And Results:
We included patients from the Myocardial-IRON trial with left and right ventricular systolic dysfunction (LVSD and RVSD, respectively) at enrolment. Linear mixed regression models were used to evaluate changes at 7 and 30 days on LVEF and RVEF at cardiac magnetic resonance. At enrolment, 27 (50.9%) and 38 (71.7%) patients had LVEF < 40% (LVSD1 ) or <45% (LVSD2 ), respectively, and 10 (18.9%) and 17 (32.1%) patients had RVEF < 45% (RVSD1 ) or <51% in women and <52% in men (RVSD2) , respectively. Treatment with FCM was associated with a significant improvement in LVEF at 30 days (LVSD1 : Δ2.3%, P < 0.001; LVSD2 : Δ4.1, P = 0.014). FCM was also associated with a significant and early improvement in RVEF at 7 days (RVSD1 : Δ6.9%, P = 0.003; RVSD2 : Δ3.2%, P = 0.003) that persisted at 30 days (RVSD1 : Δ8.1%, P < 0.001; RVSD2 : Δ4.7%, P < 0.001).
Conclusions:
In patients with HF and systolic dysfunction with ID, FCM was associated with short-term improvement in LVEF and, especially, in RVEF.
