Impact of intravenous ferric carboxymaltose on heart failure with preserved and reduced ejection fraction

Abstract

Aims Heart failure (HF) is a proinflammatory disease often associated with the onset of iron deficiency (ID). ID alters mitochondrial function, reducing the generation of cellular energy in skeletal muscle and cardiomyocytes. This study aimed to analyse the response of patients with HF to intravenous iron administration according to the type of HF: preserved ejection fraction (HFpEF) or reduced ejection fraction (HFrEF). Methods and results We conducted a retrospective, single‐centre study of 565 consecutive outpatients diagnosed with HF, recruited over 5 years, who were given intravenous ferric carboxymaltose (FCM) for the treatment of ID [defined as ferritin < 100 μg/L or ferritin 100–300 μg/L with transferrin saturation (TSAT) < 20%]. Clinical, laboratory, and echocardiographic parameters were analysed before and after administration. After FCM administration, overall ferritin, TSAT, and haemoglobin levels increased up to 5‐fold, 1.6‐fold, and 1.1‐fold, respectively, relative to baseline values in HF patients with reduced and preserved ejection fraction (P < 0.0001), with a greater increase in ferritin and TSAT in HFpEF patients. The left ventricular ejection fraction of the overall series improved by 8 percentage points in both types of HF (from 40% to 48%, P < 0.0001). The percentage of patients with normalization of right ventricular function increased by 6.9 points (from 74.1% to 81%) in HFpEF patients and by 6.4 points (from 53% to 59.4%) in the HFrEF subgroup (P < 0.0001). New York Heart Association functional status slightly improved, from a median of 2.4 (interquartile range, IQR: 2–2.7) to 1.9 (IQR: 1.5–2.5; P < 0.0001) after FCM in both types of HF. No changes were noted in plasma levels of liver enzymes, creatinine, or natriuretic peptide (P > 0.05). Conclusions Intravenous iron administration appeared to improve ejection fraction and cardiac functional status in outpatients with ID and HF with both preserved and reduced ejection fraction.

A year in heart failure: updates of clinical and preclinical findings

“…No significant differences in adverse events were observed between the treatment groups 50 . A retrospective database analysis has shown that IV iron administration appears to improve ejection fraction and cardiac functional status in outpatients with iron deficiency, HFpEF, and HFrEF 52 …”

“…50 A retrospective database analysis has shown that IV iron administration appears to improve ejection fraction and cardiac functional status in outpatients with iron deficiency, HFpEF, and HFrEF. 52 Another important aspect in the individualization of HF therapy is the use of vericiguat in patients with a recent episode of worsening HF requiring IV diuretic treatment. Using data from the VICTORIA trial, Senni et al found that plasma NT-proBNP may help to identify patients with worsening HFrEF, in whom the beneficial effects of vericiguat may be highest.…”

Determinants and treatments of heart failure after transcatheter aortic valve implantation: moving up a notch

“…127 In HF, iron deficiency can be due to an absolute decrease in total body iron or an inadequate distribution because of iron sequestration in the storage pool. 127 Although early studies provided the potential role of intravenous iron therapy in patients with HFrEF and HFpEF, 128,129 the role of iron supplementation in TAVI patients remains unconfirmed. One randomized trial is ongoing to explore the potential of intravenous iron therapy in TAVI patients (NCT 04797832) (Table 1).…”

Is the Benefit of Treating Iron Deficiency Greater in Acute Heart Failure with Renal Dysfunction?

“…In chronic HF, administration of ferric carboxymaltose (FCM) results in short-term (30 days) incorporation of iron into myocytes with an improvement of the left and right ventricular function [9,10]. In the medium term (3 months), a study by our group analysed the response of patients with HF to intravenous iron administration according to the type of HF, finding that intravenous iron administration improves ejection fraction and cardiac functional status in outpatients with ID and HF with both preserved and reduced ejection fractions [11]. Another study in the same line of research that was conducted on 890 patients who were consecutively admitted for acute heart failure (AHF) and received FCM administration before discharge showed a reduction in the combined event at 6 months (overall mortality, emergency department visits for decompensation, and readmissions) with a NNT close to 10 [12].…”