Key result
Baseline iron deficiency blunts peakVO2 gains from physical therapy in stable HFpEF.
Why the study?
Iron deficiency impairs functional capacity in HFpEF, but the effect of baseline ferrokinetics on peakVO2 improvement following physical therapy programmes remained unknown.
Does baseline ferrokinetics status (iron deficiency, serum ferritin, and transferrin saturation) modify the improvement in peak oxygen consumption (peakVO2) following a 12-week physical therapy programme (IMT, FES, or IMT + FES) compared with usual care in patients with stable symptomatic HFpEF?
RCT (n=59)
Open-label
Randomly allocated to one of four study arms
No
Does baseline ferrokinetics status (iron deficiency, serum ferritin, and transferrin saturation) modify the improvement in peak oxygen consumption (peakVO2) following a 12-week physical therapy programme (IMT, FES, or IMT + FES) compared with usual care in patients with stable symptomatic HFpEF?
This post-hoc substudy of the TRAINING-HF trial demonstrates that baseline iron deficiency (low ferritin and TSAT) blunts improvements in peakVO2 and inspiratory muscle strength following 12 weeks of physical therapy in patients with symptomatic stable HFpEF.
Baseline iron deficiency attenuates peakVO2 gains from physical therapy in HFpEF; supports prospective trials of iron repletion before rehabilitation.
Background Iron deficiency (ID) is associated with impaired functional capacity in patients with heart failure (HF), even in those with preserved ejection fraction (HFpEF). This study aimed to evaluate the effect of baseline ferrokinetics on peak oxygen consumption (peakVO 2 ) improvement after a 12‐week physical therapy programme in patients with stable HFpEF. Methods This study is a post‐hoc sub‐analysis of a randomized clinical trial in which 59 stable patients with HFpEF were randomized to receive a 12‐week programme of inspiratory muscle training (IMT), functional electrical stimulation (FES), IMT + FES or usual care (UC) to evaluate change in peakVO 2 (NCT02638961). Serum ferritin and transferrin saturation (TSAT) determinations were assessed at baseline. ID was defined as ferritin <100 ng/mL and/or TSAT <20% if ferritin was within 100–299 ng/mL. We used a linear mixed regression model to analyse between‐treatment changes in peakVO 2 across ferrokinetics status at 12 and 24 weeks. Results The mean age was 74 ± 9 years, and 36 (61%) had ID. The mean of peakVO 2 was 9.9 ± 2.5 mL/kg/min. The median of ferritin and transferrin saturation (TSAT) was 91 (50–181) ng/mL and 23% (16–30), respectively. A total of 52 patients completed the trial (13 patients per arm). Compared with those patients on UC, patients allocated to any of the active arms showed less improvement in peak VO 2 when they showed ID ( P ‐value for interaction <0.001), lower values of ferritin ( P ‐value for interaction <0.001), or TSAT ( P ‐value for interaction <0.001). Conclusions Ferrokinetics status plays an essential role in modifying the aerobic capacity response to physical therapies in patients with HFpEF. Further studies are required to confirm these findings.
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Palau et al. (2024) conducted an RCT in Symptomatic stable heart failure with preserved ejection fraction (HFpEF) (n=59). 12-week physical therapy programme (inspiratory muscle training [IMT], functional electrical stimulation [FES], or IMT + FES) stratified by baseline ferrokinetics status vs. Usual care (no physical therapy) and absence of iron deficiency was evaluated on Between-treatment change in peak oxygen consumption (peakVO2) across baseline ferrokinetics status at 12 and 24 weeks (p=<0.001 for interaction). Baseline iron deficiency, lower ferritin, and lower TSAT significantly blunted peakVO2 improvement after 12-week physical therapy in stable HFpEF patients (all P for interaction <0.001).
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