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The effect of intravenous ferric carboxymaltose on right ventricular function - insights from the IRON-CRT trial
Pieter Martens1,2, Matthias Dupont2, Jeroen Dauw2
1Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
Insights
Ferric carboxymaltose (FCM) significantly improved right ventricular (RV) function and contractile reserve in patients with heart failure with reduced ejection fraction (HFrEF). This iron deficiency treatment also correlated with enhanced left ventricular ejection fraction (LVEF) improvements.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Pharmacology
Background:
- Heart failure with reduced ejection fraction (HFrEF) affects both left and right ventricles.
- Iron deficiency is common in HFrEF and impacts cardiac function.
- The efficacy of ferric carboxymaltose (FCM) on right ventricular (RV) function in HFrEF requires further elucidation.
Purpose of the Study:
- To investigate the effects of FCM on RV function and structure in patients with HFrEF.
- To assess the impact of FCM on RV contractile reserve.
- To explore the relationship between RV function improvement and left ventricular ejection fraction (LVEF) changes.
Main Methods:
- Analysis of the IRON-CRT trial data involving HFrEF patients with iron deficiency and LVEF impairment.
- Randomized, double-blind, placebo-controlled trial of FCM versus placebo.
- RV function assessed via RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), RV S', systolic pulmonary artery pressure (SPAP), and TAPSE/SPAP ratio.
- RV contractile reserve evaluated using incremental pacing.
Main Results:
- FCM treatment led to significant improvements in RV FAC and TAPSE compared to placebo.
- A trend towards lower SPAP and significant improvement in the TAPSE/SPAP ratio was observed with FCM.
- RV contractile reserve was significantly attenuated at 3-month follow-up in the FCM group.
- Improvements in RV function correlated with greater LVEF improvements.
Conclusions:
- Ferric carboxymaltose (FCM) treatment improves RV function, structure, and contractile reserve in HFrEF patients with iron deficiency.
- FCM may offer additional benefits beyond LVEF improvement by enhancing RV performance.
- These findings support the consideration of FCM in managing HFrEF patients with concomitant iron deficiency and RV dysfunction.
Aims:
Ferric carboxymaltose (FCM) improves left ventricular function in heart failure with reduced ejection fraction (HFrEF). Yet, the effect of FCM on right ventricular (RV) function remains insufficiently elucidated.
Methods And Results:
This is a pre-defined analysis of the IRON-CRT trial in which symptomatic HFrEF patients with iron deficiency and reduced left ventricular ejection fraction (LVEF) despite optimal medical therapy and cardiac resynchronization therapy (CRT) underwent 1:1 randomization to FCM or placebo in a double-blind fashion. RV function was measured as the change from baseline to 3-month follow-up in RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and pulsed Doppler peak velocity at the RV lateral annulus (RV S'), systolic pulmonary artery pressure (SPAP) and its coupling to the right ventricle (TAPSE/SPAP ratio). The RV contractile reserve was measured as the change in TAPSE during incremental pacing at 70, 90 and 110 bpm. A total of 75 patients underwent randomization and received FCM (n = 37) or placebo (n = 38). At baseline 72.5% had RV dysfunction and 70% had RV dilatation. At 3-month follow-up, patients receiving FCM had a significant improvement in RV FAC (+4.1% [+1.4% - +6.9%] vs. -2.2% [-4.9% - +0.6%] in the placebo group, p = 0.002) and TAPSE (+0.98 mm [+0.28 mm - +1.62 mm] vs. -0.19 mm [-0.85 mm - +0.48 mm] in the placebo group, p = 0.020), but not RV S'. Patients receiving FCM had a numerically lower SPAP (p = 0.073) and significant improvement in TAPSE/SPAP ratio (+0.097 [+0.048 - +0.146] vs. +0.002 [-0.046 - +0.051] in the placebo group, p = 0.008). At baseline both groups had diminished RV contractile reserve during incremental pacing, which was attenuated at 3-month follow-up in the FCM group (p = 0.004). Patients manifesting more RV function improvement were more likely to exhibit higher degrees of LVEF improvement (p < 0.05 for all).
Conclusions:
Treatment with FCM in HFrEF patients results in an improvement in RV function and structure and improves the RV contractile reserve.
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