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Myocardial Performance Improvement After Iron Replacement in Heart Failure Patients: The IRON-PATH II Echo-Substudy

Raúl Ramos-Polo1,2,3,4,5, Maria Del Mar Ras-Jiménez3,5,6, María Del Carmen Basalo Carbajales1,2

  • 1Cardiology Department, Heart Institute, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.

Journal of Clinical Medicine
|June 26, 2025
PubMed

Insights

Iron deficiency in heart failure patients impairs cardiac function, affecting both left and right ventricles. Intravenous iron repletion significantly improved heart function, reversing these detrimental effects.

Area of Science:

  • Cardiology
  • Cardiovascular Physiology
  • Iron Metabolism

Background:

  • Iron deficiency (ID) is a common comorbidity in heart failure (HF) patients, linked to poor prognosis and reduced physical capacity.
  • ID-related functional limitations can cause cardiac function abnormalities, potentially reversible with iron repletion.
  • Echocardiographic parameters like global longitudinal strain (GLS) and myocardial work (MW) aid in assessing cardiac performance.

Purpose of the Study:

  • To investigate the association between iron deficiency and cardiac function in heart failure patients.
  • To evaluate the impact of iron repletion on myocardial performance in this cohort.
  • To explore the utility of advanced echocardiographic parameters in assessing ID-related cardiac dysfunction.

Main Methods:

  • The IRON-PATH II echo-substudy prospectively observed 98 heart failure patients with LVEF ≤50% and hemoglobin ≥11 g/dL.
  • Echocardiographic evaluations included GLS, MW, constructive work (CW), wasted work (WW), and work efficiency (WE).
  • Patients with ID underwent intravenous iron repletion, with post-treatment assessments compared to baseline and non-ID patients.

Main Results:

  • Iron deficiency patients exhibited significantly worse cardiac function, including lower GLS, WE, MW, and RV free wall strain, alongside higher WW.
  • Following intravenous iron repletion, ID patients showed marked improvements in LV and RV performance metrics.
  • Post-repletion cardiac function in ID patients aligned with that of non-ID patients, indicating reversibility of dysfunction.

Conclusions:

  • Iron deficiency is associated with impaired left and right ventricular myocardial performance in heart failure patients with reduced ejection fraction.
  • Intravenous iron repletion effectively reverses cardiac dysfunction in HF patients with ID.
  • Advanced echocardiographic parameters are valuable in detecting and monitoring ID-related cardiac changes in HF.

Keywords:
chronic heart failurecomorbiditiesechocardiographyiron deficiencymyocardial work

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