scholarly journals Faculty Opinions recommendation of Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency.

Author(s):  
Amil Shah
Circulation ◽  
2017 ◽  
Vol 136 (15) ◽  
pp. 1374-1383 ◽  
Author(s):  
Dirk J. van Veldhuisen ◽  
Piotr Ponikowski ◽  
Peter van der Meer ◽  
Marco Metra ◽  
Michael Böhm ◽  
...  

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Ebner ◽  
G Dinopoulos ◽  
R Evertz ◽  
T Garfias Macedo ◽  
B Godoy ◽  
...  

Abstract Background Anaemia and iron deficiency (ID) are important factors for muscle function and exercise capacity in patients with chronic heart failure (HF). Their interaction in HF remains to be defined. Methods A total of 280 out-patients with stable chronic HF were enrolled with mean age of 67.0±10.7 years, 21%female, mean left ventricular ejection fraction (LVEF) was 38.9±13.4%, mean Body Mass Index (BMI) 29.3±5.5 kg/m2]. Anaemia was defined according to World Health Organization criteria [Haemoglobin (Hb) <13 g/dL in men and <12 g/dL in women]. ID was defined as ferritin <100 μg/L or ferritin <100 <300 μg/L than with transferrin saturation (TSAT) <20%. Exercise capacity was assessed by spiroergometry (peakVO2), 6 minute walk test (6MWT), short physical performance battery test (SPPB), hang grip strength (HGS) and leg force (LF). All patients were followed up for a mean of 8 month. Results A total of 89 (32%) chronic HF patients had anaemia and 142 (51%) had iron deficiency at baseline. Patients with anaemia showed significant lower exercise capacity compared to patients without anaemia (peak VO2: 15.3±4.6 vs. 18.5±4.8 kg/min p<0.0001, 6MWT: 365.2±135.5 vs. 461.6±127.4 m p<0.0001, SPPB: 9.4±2.3 vs. 11.0±1.6 total points p<0.0001, HGS: 32.5±10.0 vs. 38.8±12.4 kg p<0.0001, LF: 31.4±11.0 vs. 41.3±21.6 kg p<0.0001). The same we found in patients with ID compared to patients without ID (peak VO2: 16.3±5.1 vs. 18.6±4.5 kg/min p=0.001, 6MWT: 400.0±140.8 vs. 458.8±128.4 m p=0.0008, SPPB: 10.0±2.1 vs. 10.9±1.7 total points p=0.0003, HGS: 34.5±11.9 vs. 39.3±11.7 kg p=0.001, LF: 35.7±23.4 vs. 40.5±13.6 kg p=0.04). After a Follow up of mean 8 month 53 patients develop a new onset of either anaemia (n=24) or ID (n=29). Logistic regression analysis showed that gender, 6 minute walk distance, SPPB, HGS and presence of diabetes mellitus at baseline are significantly associated with the development of anaemia or ID (all p<0.05). The strongest predictor was lower SPPB (p=0.0008). Interestingly known determinates lower peak VO2, higher age, higher NYHA class, Creatinine, and hsCRP were not predictive in our cohort to develop anaemia or ID after 8 month (all p>0.05). Conclusion Both anaemia and ID are strongly associated with reduced exercise capacity in patients with HF. The effect of anaemia and iron deficiency together is stronger than that of anemia and ID alone. Reduced SPPB, 6MWT, and HGS are important risk factors for the development of anaemia or ID.


2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Abdul Razzack ◽  
S Kumar ◽  
R Kumar ◽  
HT Khokhar ◽  
S Pothuru ◽  
...  

Abstract Funding Acknowledgements Type of funding sources: None. Background-Iron deficiency is prevalent in heart failure patients and is associated with unfavorable clinical outcomes, irrespective of anemia status. The 2016 European Society of Cardiology (ESC) guidelines recommended intravenous ferric carboxymaltose (FCM) for the management of acute and chronic heart failure in symptomatic HF with reduced ejection fraction (EF).  Objective- To determine whether the correction of iron deficiency with ferric carboxymaltose confers better clinical outcomes in patients with acute and chronic heart failure Methods-Electronic databases ( PubMed, Embase, Scopus, Cochrane) were searched from inception to December 28th, 2020. Unadjusted odds ratios (OR) were calculated from dichotomous data using Mantel Haenszel (M-H) random-effects with statistical significance to be considered if the confidence interval excludes 1 and p &lt; 0.05. The primary outcome of interest was cardiac mortality.  Secondary outcomes included first hospitalisation due to worsening heart failure and any other cardiovascular (CV) reason. Results-A total of five studies with 2091( FCM = 1125; placebo = 966) patients were included. Average follow-up period was 2 years. There was no difference in terms of cardiac mortality (RR 0.93, 95% CI 0.71–1.21; p = 0.57; I2 = 0) and hospitalizations for any CV reason (RR 0.83, 95% CI 0.32–2.16; p = 0.70; I2 = 83) with either group at the end of follow-up. As compared to placebo, FCM was associated with significant reduction in hospitalization due to worsening heart failure (RR 0.64; 95% CI 0.41-0.99; p = 0.04; I2 = 56)  Conclusion- Amongst patients with iron-deficient acute and chronic heart failure, treatment with ferric carboxymaltose reduced the risk of heart failure hospitalizations, with no apparent effect on the risk of cardiac mortality and hospitalizations for any other CV cause. Abstract Figure. A)CV death B&C)Hospitalizations-HF,CV


Author(s):  
Juan F. Delgado ◽  
Juan Oliva ◽  
Álvaro González-Franco ◽  
Jose María Cepeda ◽  
Jose Ángel García-García ◽  
...  

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