What is the clinical evidence from this study?

Study design: Observational. Population: Heart failure with reduced ejection fraction and iron deficiency (n=98). Intervention: Intravenous ferric carboxymaltose vs. Baseline (pre-treatment). Primary outcome: Change in global longitudinal strain (GLS) (p=<0.05).

February 25, 2025Open Access

Myocardial performance improvement after iron replacement in heart failure patients: The IRON-PATH II echo-substudy

Q: What are the key findings of this study?

Intravenous iron repletion in heart failure patients with reduced ejection fraction and iron deficiency significantly improved left ventricular global longitudinal strain from -8.5% to -9.3%.

Resultado clave

Intravenous iron repletion in heart failure patients with reduced ejection fraction and iron deficiency significantly improved left ventricular global longitudinal strain from -8.5% to -9.3%.

Diseño del estudio

Tipo

Observational (n=98)

Enmascaramiento

Single-blind

Multicéntrico

PICO estructurado

Does intravenous ferric carboxymaltose improve echocardiographic parameters of myocardial performance in heart failure patients with LVEF ≤50% and iron deficiency?

Población

98 heart failure patients with LVEF ≤50%, stable clinical condition, on standard HF medication, and hemoglobin ≥11 g/dL. Mean age 74±8 (ID group) vs 70±11 (non-ID group), 78% male (ID group). Recruited at a single center in Spain.

Intervención

Intravenous ferric carboxymaltose (maximum 1000 mg at once, second dose if needed) administered over 30-60 minutes, with reassessment at 3 months.

Comparador

Non-iron deficient heart failure patients (baseline comparison) and pre-treatment baseline of the iron deficient group.

Resultado

Change in cardiac performance, including LVEF and LV deformation parameters (GLS and its derivates MW, WW, CW and WE) after iron replenishment at 3 months.surrogate

Resultado numérico

Tasa de eventos absoluta: -9.3% vs -8.5%

valor p: p=<0.05

Limitaciones

Echocardiography-based study without cMRI comparison
Speckle-tracking requires experience and depends on image quality
Noninvasive arterial pressure used for myocardial work calculation can be variable
Baseline differences between groups (ID patients were older, had more atrial fibrillation, and lower hemoglobin)

Resumen

Abstract Iron deficiency (ID) is a prevalent comorbidity in heart failure (HF) patients associated with poor prognosis and impaired physical capacity. Functional limitations linked to ID may be related to cardiac function abnormalities, which could be reversible with iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW), and its derivatives constructive work (CW), wasted work (WW), and work efficiency (WE), may provide additive value in advanced cardiac performance assessment. The IRON-PATH II was a multicenter, prospective and observational study designed to describe pathophysiological pathways associated to ID. The echo-substudy included 100 HF patients undergoing a specific pilot echocardiographic evaluation. Patients had left ventricular ejection fraction (LVEF) ≤50%, were in stable clinical condition, on standard HF medication, and with hemoglobin ≥11 g/dL. The final cohort included 98 patients. The ID group showed worse cardiac function, with lower GLS (–8.5±9% vs –10±10%), WE (74±10% vs 80±10%), and MW (665453-1013 vs 947542-1199 mmHg%), as well as higher WW (290228-384 vs 212138-305 mmHg%) and lower RV free wall strain (–13-20-(–11) % vs –17-23-(–14) %). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE, and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all p-values >0.05 compared to the non-ID group). In conclusion, among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV, with these alterations being reversible after intravenous iron repletion. Abstract Figure Graphical Abstract

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