Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency
Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency
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DOI：
10.1016/j.jacc.2007.09.036
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发表时间：
2008-01-15
影响因子：
24
通讯作者：
Ponikowski, Piotr
中科院分区：
文献类型：
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作者：
Okonko, Darlington O.;Grzeslo, Agnieszka;Ponikowski, Piotr
目的我们验证了静脉铁剂可以改善贫血和非贫血的慢性心力衰竭（CHF）患者运动耐量的假说。铁代谢紊乱，补铁可改善症状和运动耐量。（年龄64 +/- 13岁，峰值耗氧量[pVo（2）] 14.0 +/- 2.7 ml/kg/ min）至16周静脉铁剂（每周200 mg，直到铁蛋白> 500 ng/ml，此后每月200 mg）或不治疗。要求铁蛋白< 100 ng/ml或铁蛋白100 - 300 ng/ml，转铁蛋白饱和度<20%。根据血红蛋白水平对患者进行分层（< 12.5 g/dl [贫血组] vs. 12.5 - 14.5 g/dl [非贫血组]）。双盲主要终点为PVo（2）绝对值的变化。铁剂组和对照组从基线至研究结束的平均变化（95%置信区间[CI]）为273（151至396）ng/ml（铁蛋白）（p < 0.0001），0.1血红蛋白（-0.8至0.9）g/dl（p = 0.9），96绝对pVo（2）为（-12至205）ml/min（P = 0.08），2.2（0.5 - 4.0）ml/kg/min，pVo（2）/kg（p = 0.01），60（-6至126）s的跑步机运动持续时间（p = 0.08），纽约心脏协会（NYHA）心功能分级为-0.6（-0.9至-0.2）（p = 0.007），患者总体评估为1.7（0.7至2.6）（p = 0.002）。在贫血患者（n = 18）中，绝对PVo（2）的差异（95% CI）为204（31 - 378）ml/min（P = 0.02），pVo（2）/kg的差异（95% CI）为3.9（1.1 - 6.8）ml/kg/min（p = 0.01）。在非贫血患者中，NYHA心功能分级改善（p = 0.06）。结论静脉铁负荷可改善CHF患者的运动能力和症状，并有铁代谢异常的证据。在贫血患者中获益更为明显。（静脉注射蔗糖亚铁对慢性心力衰竭患者运动能力的影响; http：//www.clinicaltrials.gov/ct/show/NCT00125996; NCT 00125996）。
Objectives We tested the hypothesis that intravenous iron improves exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure (CHF) and iron deficiency.Background Anemia is common in heart failure. Iron metabolism is disturbed, and administration of iron might improve both symptoms and exercise tolerance.Methods We randomized 35 patients with CHIF (age 64 +/- 13 years, peak oxygen consumption [pVo(2)] 14.0 +/- 2.7 ml/kg/ min) to 16 weeks of intravenous iron (200 mg weekly until ferritin > 500 ng/ml, 200 mg monthly thereafter) or no treatment in a 2:1 ratio. Ferritin was required to be < 100 ng/ml or ferritin 100 to 300 ng/ml with transferrin saturation < 20%. Patients were stratified according to hemoglobin levels (< 12.5 g/dl [anemic group] vs. 12.5 to 14.5 g/dl [nonanemic group]). The observer-blinded primary end point was the change in absolute PVo(2).Results The difference (95% confidence interval [CI]) in the mean changes from baseline to end of study between the iron and control groups was 273 (151 to 396) ng/ml for ferritin (p < 0.0001), 0.1 (-0.8 to 0.9) g/dl for hemoglobin (p = 0.9), 96 (-12 to 205) ml/min for absolute pVo(2) (P = 0.08), 2.2 (0.5 to 4.0) ml/kg/min for pVo(2)/kg (p = 0.01), 60 (-6 to 126) s for treadmill exercise duration (p = 0.08), -0.6 (-0.9 to -0.2) for New York Heart Association (NYHA) functional class (p = 0.007), and 1.7 (0.7 to 2.6) for patient global assessment (p = 0.002). In anemic patients (n = 18), the difference (95% CI) was 204 (31 to 378) ml/min for absolute PVo(2) (P = 0.02), and 3.9 (1.1 to 6.8) ml/kg/min for pVo(2)/kg (p = 0.01). In nonanemic patients, NYHA functional class improved (p = 0.06). Adverse events were similar.Conclusions Intravenous iron loading improved exercise capacity and symptoms in patients with CHF and evidence of abnormal iron metabolism. Benefits were more evident in anemic patients. (Effect of Intravenous Ferrous Sucrose on Exercise Capacity in Chronic Heart Failure; http://www.clinicaltrials.gov/ct/show/NCT00125996; NCT00125996).