Effect of ferrotherapy on clinical and instrumental indices in patients with chronic heart failure with reduced left ventricular ejection fraction and concomitant latent iron deficiency


Keywords: chronic heart failure, latent iron deficiency, oral ferrotherapy

Abstract

The objective of the study was to assess changes of clinical and instrumental indices in patients with chronic heart failure (CHF) with reduced left ventricular (LV) ejection fraction (EF) and concomitant latent iron deficiency (ID) on the background of the standard treatment in combination with 6-months oral ferrotherapy. 60 patients with CHF with reduced LV EF functional class (FC) II-III according to NYHA with concomitant latent ID were examined. Among them were 41 (68.3%) men and 19 (37.1%) women aged 68.3±0.63 years. Two groups of patients with CHF and latent iron deficiency were formed: the 1st group (n=30) received a standard therapy, the patients in the 2nd group (n=30) were additionally prescribed oral ferrous sulfate in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid per day for 6 months. Number of red blood cells (Rbc), hemoglobin (Hb) level, serum iron (SI), ferritin, transferrin saturation (ТS), 6-minute walk stress test (6MWT), MLHFQ and MOS SF36 questionnaire and LV morpho-functional parameters by echocardiography were determined. The studied values are presented as a median (upper, lower quartile). After the therapy the values of Hb, Rbc, SI, ferritin and TS have significantly increased in the 2nd group. But in the 1st group due to the lack of ferrocorrection, in most cases, the values have reduced. An increase of the covered 6MWT distance, MLHFQ points, physical (PH) and mental (MH) components of health of MOS SF36 was observed in both groups: in the first group only by 5.3 (р=0.06), 1.2 (р=0.46), 6.9 (р=0.31) and 7.2% (р=0.02), respectively. Whereas in the second group by 13.8 (p<0.001), 13.6 (p<0.001), 24% (p<0.001) and 15% (p<0.001), respectively. EDD (end-diastolic dimension) decreased by 2.1% (p<0.001), EDV (end-diastolic volume) — by 4.8% (p<0.001), ESD (end-systolic dimension) — by 3.9% (p<0.001), ESV (end-systolic volume) — by 13.3% (p<0.0001), EF has increased by 12.7% (p<0.001) in the first group. No difference in the dynamics of the Echo-CG indices between two groups of patients over 6 months of observation was detected (р>0.18). EDD decreased by 2.7% (p<0.001), EDV — by 3.9% (p<0.0001), ESD — by 3.9%, ESV — by 10.9% (p<0.0001), EF has increased by 16.3% (p<0.0001).Thus, the positive hematological changes in case of latent ID correction in patients with CHF with reduced LV EF, despite the similar dynamics of myocardium morpho-functional indices in case of absent ferrocorrection, are accompanied by more significant positive dynamics of effort tolerance and quality of life.

References

1. Voronkov, L. G. (2015). Anemiia u patsiienta z KhSN: yak otsiniuvaty ta likuvaty? [Anemia in a patient with CHF: how to evaluate and how to treat?]. Sertseva nedostatnist – Heart Failure, 2, 5–13.

2. Mozhina, T. L. (2017). Zhelezodefitsit v praktike semeynogo vracha [Iron deficiency in the practice of a family doctor]. Zdorovia Ukrainy ХХІ storichchia – Health of Ukraine of the XXI century, 24, 44–45. Vziato z https://health-ua.com/multimedia/userfiles/files/2017/ZU_24_2017/ZU-24-17_p44-45.pdf.

3. Anker, S. D., Colet, J. C., Filippatos, G, Willenheimer, R., Dickstein, K., Drexler, H., … Ponikowski, P. (2009). Ferric carboxymaltose in patients with heart failure and iron deficiency. N. Engl. J. Med., 361 (25), 2436–48. doi: 10.1056/NEJMoa0908355.

4. Comin-Colet, J., Enjuanes, C., Gonzalez, G., Torrens, A., Cladellas, M., Merono, O., … Bruguera, J. (2013). Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. Europ. J. of Heart Failure, 15, 1164–72. doi: 10.1093/eurjhf/hft083.

5. Cunha, G. J. L., Rocha, B. M. L. & Menezes Falcão, L. (2018). Iron deficiency in chronic and acute heart failure: A contemporary review on intertwined conditions. Eur. J. Intern. Med., 52, 1–7. doi: 10.1016/j.ejim.2018.04.013.

6. Duygu, K. & Kadri, M. G. (2016). Iron deficiency and its treatment in heart failure: indications and effect on prognosis. E-Journal of Cardiology Practice, 14 (30). Retrieved from: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Iron-deficiency-and-its-treatment-in-heart-failure-indications-and-effect-on-prognosis.

7. Mamas, M., Sperrin, M., Watson, M., Coutts, A., Wilde, K., Burton, C., … Myint, P. K. (2017). Do patients have worse outcomes in heart failure than in cancer? A primary carebased cohort study with 10-year follow-up in Scotland. Eur. J. Heart Fail., 19, 1095–1104. doi: 10.1002/ejhf.822.

8. Nanas, J. N., Matsouka, C., Karageorgopoulos, D., Leonti, A., Tsolakis. E., Drakos, S. G., Tsagalou, E. P., Maroulidis, G. D., Alexopoulos, G. P., Kanakakis, J. E. & Anastasiou-Nana, M. I. (2006). Etiology of anemia in patients with advanced heart failure. J. Am. Coll Cardiol., 48 (12), 2485–9. DOI: 10.1016/j.jacc.2006.08.034.

9. Okonko, D. O., Grzeslo, A., Witkowsk, T. І., Mandal, A. K., Slater, R. M., Roughton, M., Foldes, G., Thum, T., Majda, J., Banasiak, W., Missouris, C. G., Poole-Wilson, P.A., Anker, S. D. & Ponikowski, P. (2008). Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J. Am. Coll Cardiol., 51 (2), 103–12. doi: 10.1016/j.jacc.2007.09.036.

10. Pocock, S. J, Ariti, C. A., McMurray, J. V., Maggioni, A., Køber, L., Squire, I.B., … Doughty, R. N. (2013). Predicting survival in heart failure: a risk score based on 39372 patients from 30 studies. Eur. Heart J., 34: 1404–13. doi: 10.1093/eurheartj/ehs337.
Published
2019-09-02
How to Cite
Ivanov, V., Kolesnyk, M., & KolesnуkO. (2019). Effect of ferrotherapy on clinical and instrumental indices in patients with chronic heart failure with reduced left ventricular ejection fraction and concomitant latent iron deficiency. Reports of Vinnytsia National Medical University, 23(3), 382-388. https://doi.org/https://doi.org/10.31393/reports-vnmedical-2019-23(3)-07