Abstract

Objective: This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) in patient who had heart failure, and iron deficiency, either with or without anemia, would improve hematological and biochemical response, clinical determinants of the patients and functional status and capacity of the patients. Background: Recently it has been recognized that patients with heart failure (HF) may be prone to the development of iron deficiency (ID). Iron deficiency with or without anaemia diminishes aerobic performance, precipitates fatigue and exercise intolerance and consequently worsens the clinical symptoms of patients with HF. A recent randomized, double-blind study (Anker et al. 2009) showed that intravenous iron supplementation in ID patients with or without anemia and chronic heart failure (CHF) exerts favorable effects on functional status and quality of life. Therefore ID lately acquired a unique role in the field of HF and is the subject of novel studies. Methods: This prospective pre test and post test design study has been conducted in SRN hospital, M.L.N medical college, Prayagraj over 50 clinically stable patient of heart failure of NYHA class II or III, a left ventricular ejection fraction 45% or less with iron deficiency (ferritin level <100 micro gm per litre or between 100 and 299 micro gm per liter, if the transferrin saturation was <20%). Exercise capacity has been quantified using six minute walk test. Then patient has been received bolus of ferric carboxymaltose over 30 minute. Reassessment of symptoms of patients was made according to NYHA functional classification and exercise capacity using 6 minute walk test on day 90. Results: On day 90 it was observed that treatment with FCM significantly prolonged 6 MWT distance (pre-treatment 254.3±45.3 m vs. post-treatment 353.6±45.6 m, p value - <0.05), an improvement in NYHA was detected with statistical significance (p value <0.05), statistically significant reduction in value of BNP (pre-treatment 1174.6±560.6 pg/mL vs post-treatment 898.3±451.5 pg/mL, P value- <0.05) observed. Conclusion: Treatment with intra venous iron in patients with chronic heart failure and iron deficiency anemia, improves symptoms of heart failure, functional capacity and quality of life.

Description

The European Society of Cardiology Heart Failure Survey indicate that 74% of chronic heart failure patients have at least one co morbidity, the most common of which are diabetes, renal dysfunction and anemia. The pathogenesis of anemia in heart failure patients is considered to be complex and multi factorial, consisting of elements such as renal dysfunction, decreased erythropoietin production and resistance, hemdilution, chronic inflammation, and in particular iron deficiency 1 . Recently it has been recognized that patients with heart failure (HF) may be prone to the development of iron deficiency (ID) as a result of depletion of iron stores, or due to mechanisms present in anemia of chronic disease 2, 3 . ID with or without anaemia diminishes aerobic performance, precipitates fatigue and exercise in tolerance and consequently worsens the clinical symptoms of patients with HF 4 . A recent randomized double-blind study showed that intravenous iron supplementation in ID patients with or without anaemia and chronic heart failure (CHF) exerts favourable effects on functional status and quality of life. Therefore ID lately acquired a unique role in the field of HF and is the subject of novel studies