The Outcome of Use of Intravenous Iron Carboxymaltose on the NYHA Class and the Six-Minute Walk-Test in Patients with Heart Failure: Assessing Functional Improvement
Article Sidebar
Main Article Content
Abstract
BACKGROUND: Chronic heart failure (CHF) significantly impairs quality of life and exercise capacity, often exacerbated by concurrent iron deficiency. Intravenous ferric-carboxymaltose (FCM) has shown promise in addressing these deficiencies, improving both biomarkers of iron status and functional outcomes.
OBJECTIVE: To evaluate the effects of intravenous ferric-carboxymaltose on functional class and exercise capacity, as measured by the six-minute walk-test (6MWT), in patients with iron-deficient chronic heart failure.
METHODS: This prospective, single-arm study was conducted from April to September 2023 at the Cardiology unit of Frontier Corps Teaching Hospital, Shakas Peshawar, and Mardan Medical Complex, Mardan, Pakistan. Participants underwent baseline evaluations including demographic information, medical histories, physical examinations, and functional tests such as the 6MWT. Follow-up evaluations after three months of FCM therapy assessed changes in functional indicators. Statistical analyses included tests for significance and descriptive statistics.
RESULTS: Sixty patients participated, with a mean age of 55.87 ± 13.22 years and a mean BMI of 28.14 ± 9.71 kg/m^2. Initial assessments showed a mean LVEF of 33.54 ± 6.68%, with 75% classified as NYHA class III. Baseline 6MWT completion was 10 laps. Initial mean hemoglobin was 11.82 g%, MCV 78.48 fl, TSat 20.43%, and serum iron 50.55 mcg/dL. After treatment, hemoglobin increased to 13.65 g%, MCV to 80.23 fl, TSat to 23.05%, and serum iron to 55.40 mcg/dL. Participants completed 19 laps in the 6MWT, with 63.34% improving to NYHA class II. P-values were <0.0001 for these changes, indicating statistical significance.
CONCLUSION: Intravenous ferric-carboxymaltose significantly enhances functional capacity and iron status in patients with CHF and iron deficiency, irrespective of anemia status. Future research should explore how comorbid conditions like hypertension, diabetes, and renal failure influence treatment outcomes.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Savarese G, Becher PM, Lund LH, Seferovic P, Rosano GMC, Coats AJS. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272-87. Available from: https://doi.org/10.1093/cvr/cvac013
Malik A, Brito D, Vaqar S, et al. Congestive Heart Failure. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430873/
Savarese G, von Haehling S, Butler J, Cleland JGF, Ponikowski P, Anker SD. Iron deficiency and cardiovascular disease. Eur Heart J. 2023;44(1):14-27. Available from: https://doi.org/10.1093/eurheartj/ehac569
Loncar G, Obradovic D, Thiele H, von Haehling S, Lainscak M. Iron deficiency in heart failure. ESC Heart Fail. 2021;8(4):2368-79. Available from: https://doi.org/10.1002/ehf2.13265
Hamed M, Elseidy SA, Ahmed A, Thakker R, Mansoor H, Khalili H, Mohsen A, Mamas MA, Banerjee S, Kumbhani DJ, Elgendy IY, Elbadawi A. Intravenous iron therapy among patients with heart failure and iron deficiency: An updated meta-analysis of randomized controlled trials. Heliyon. 2023;9(6):e17245. Available from: https://doi.org/10.1016/j.heliyon.2023.e17245
Singer CE, Vasile CM, Popescu M, Popescu AIS, Marginean IC, Iacob GA, Popescu MD, Marginean CM. Role of Iron Deficiency in Heart Failure-Clinical and Treatment Approach: An Overview. Diagnostics (Basel). 2023;13(2):304. Available from: https://doi.org/10.3390/diagnostics13020304
Alnuwaysir RIS, Hoes MF, van Veldhuisen DJ, van der Meer P, Grote Beverborg N. Iron Deficiency in Heart Failure: Mechanisms and Pathophysiology. J Clin Med. 2021;11(1):125. Available from: https://doi.org/10.3390/jcm11010125
Heidenreich P, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022 May;79(17):e263-e421. Available from: https://doi.org/10.1016/j.jacc.2021.12.012
Szklarz M, Gontarz-Nowak K, Matuszewski W, Bandurska-Stankiewicz E. Can Iron Play a Crucial Role in Maintaining Cardiovascular Health in the 21st Century? Int J Environ Res Public Health. 2022;19(19):11990. Available from: https://doi.org/10.3390/ijerph191911990
Toblli JE, Angerosa M. Optimizing iron delivery in the management of anemia: patient considerations and the role of ferric carboxymaltose. Drug Des Devel Ther. 2014;8:2475-91. Available from: https://doi.org/10.2147/DDDT.S55499
Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, McDonagh T, Parkhomenko A, Tavazzi L, Levesque V, Mori C, Roubert B, Filippatos G, Ruschitzka F, Anker SD; CONFIRM-HF Investigators. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency†. Eur Heart J. 2015;36(11):657-68. Available from: https://doi.org/10.1093/eurheartj/ehu385
McEwan P, Ponikowski P, Davis JA, Rosano G, Coats AJS, Dorigotti F, O'Sullivan D, Ramirez de Arellano A, Jankowska EA. Ferric carboxymaltose for the treatment of iron deficiency in heart failure: a multinational cost-effectiveness analysis utilising AFFIRM-AHF. Eur J Heart Fail. 2021;23(10):1687-97. Available from: https://doi.org/10.1002/ejhf.2270
Zhang H, Dhalla NS. The Role of Pro-Inflammatory Cytokines in the Pathogenesis of Cardiovascular Disease. Int J Mol Sci. 2024;25(2):1082. Available from: https://doi.org/10.3390/ijms25021082
Camaschella C, Nai A, Silvestri L. Iron metabolism and iron disorders revisited in the hepcidin era. Haematologica. 2020;105(2):260-72. Available from: https://doi.org/10.3324/haematol.2019.232124
Lewis GD, Malhotra R, Hernandez AF, et al. Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial. JAMA. 2017;317(19):1958-66. Available from: https://doi.org/10.1001/jama.2017.5427
Yeo TJ, Yeo PSD, Hadi FA, Cushway T, Lee KY, Yin FF, Ching A, Li R, Loh SY, Lim SL, Wong RC, Tai BC, Richards AM, Lam CSP. Single-dose intravenous iron in Southeast Asian heart failure patients: A pilot randomized placebo-controlled study (PRACTICE-ASIA-HF). ESC Heart Fail. 2018;5(2):344-53. Available from: https://doi.org/10.1002/ehf2.12250
Ponikowski P, van Veldhuisen DJ, Comin-Colet J, Ertl G, Komajda M, Mareev V, McDonagh T, Parkhomenko A, Tavazzi L, Levesque V, Mori C, Roubert B, Filippatos G, Ruschitzka F, Anker SD; CONFIRM-HF Investigators. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J. 2015;36(11):657-68. Available from: https://doi.org/10.1093/eurheartj/ehu385
Dhoot S, Mittal S, Singh SP, Patel V, Kasliwal RR, Mehta V. Effect of ferric-carboxy maltose on oxygen kinetics and functional status in heart failure patients with iron deficiency. Future Science OA. 2020 Mar 31;6(5):FSO467.
Prajapati R, Ahmad Z. Effects of intravenous iron therapy in patients with heart failure with iron deficiency.
Esteban-Fernández A, Méndez-Bailón M, Pérez-Serrano M, González-Barja M, Tornero-Molina F, Martín-Sánchez FJ, Ramírez-Ramos C, Bover-Freire R. Predictors of clinical improvement in heart failure patients with iron deficiency treated with ferric carboxymaltose. REC: CardioClinics. 2021 Oct 1;56(4):250-7.
Chien CV, Rosman LA. Measuring Clinically Important Changes in Patients With Heart Failure. Journal of Cardiac Failure. 2023 May 1;29(5):771-3.