Ruiter Gerrina, Manders Emmy, Happé Chris M, Schalij Ingrid, Groepenhoff Herman, Howard Luke S, Wilkins Martin R, Bogaard Harm J, Westerhof Nico, van der Laarse Willem J, de Man Frances S, Vonk-Noordegraaf Anton
Department of Pulmonology, Institute for Cardiovascular Research, Vrije Universiteit (VU) University Medical Center, Amsterdam, The Netherlands ; Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
Department of Physiology, Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands.
Pulm Circ. 2015 Sep;5(3):466-72. doi: 10.1086/682217.
In patients with idiopathic pulmonary arterial hypertension (iPAH), iron deficiency is common and has been associated with reduced exercise capacity and worse survival. Previous studies have shown beneficial effects of intravenous iron administration. In this study, we investigated the use of intravenous iron therapy in iron-deficient iPAH patients in terms of safety and effects on exercise capacity, and we studied whether altered exercise capacity resulted from changes in right ventricular (RV) function and skeletal muscle oxygen handling. Fifteen patients with iPAH and iron deficiency were included. Patients underwent a 6-minute walk test, cardiopulmonary exercise tests, cardiac magnetic resonance imaging, and a quadriceps muscle biopsy and completed a quality-of-life questionnaire before and 12 weeks after receiving a high dose of intravenous iron. The primary end point, 6-minute walk distance, was not significantly changed after 12 weeks (409 ± 110 m before vs. 428 ± 94 m after; P = 0.07). Secondary end points showed that intravenous iron administration was well tolerated and increased body iron stores in all patients. In addition, exercise endurance time (P < 0.001) and aerobic capacity (P < 0.001) increased significantly after iron therapy. This coincided with improved oxygen handling in quadriceps muscle cells, although cardiac function at rest and maximal [Formula: see text] were unchanged. Furthermore, iron treatment was associated with improved quality of life (P < 0.05). In conclusion, intravenous iron therapy in iron-deficient iPAH patients improves exercise endurance capacity. This could not be explained by improved RV function; however, increased quadriceps muscle oxygen handling may play a role. (
ClinicalTrials.gov identifier NCT01288651).
在特发性肺动脉高压（iPAH）患者中，缺铁很常见，且与运动能力下降和较差的生存率相关。既往研究显示静脉补铁有有益作用。在本研究中，我们就安全性以及对运动能力的影响，对缺铁的iPAH患者静脉补铁治疗进行了研究，并且探讨了运动能力的改变是否源于右心室（RV）功能和骨骼肌氧利用的变化。纳入了15例iPAH合并缺铁的患者。患者在接受高剂量静脉补铁前及补铁12周后，进行了6分钟步行试验、心肺运动试验、心脏磁共振成像、股四头肌活检，并完成了生活质量问卷。主要终点指标6分钟步行距离在12周后无显著变化（治疗前为409±110米，治疗后为428±94米；P=0.07）。次要终点指标显示，静脉补铁耐受性良好，所有患者体内铁储备均增加。此外，补铁治疗后运动耐力时间（P<0.001）和有氧运动能力（P<0.001）显著增加。尽管静息和最大[公式：见正文]时心脏功能未改变，但这与股四头肌细胞氧利用改善一致。此外，补铁治疗与生活质量改善相关（P<0.05）。总之，缺铁的iPAH患者静脉补铁治疗可改善运动耐力。这无法用RV功能改善来解释；然而，股四头肌氧利用增加可能起了作用。（试验注册：ClinicalTrials.gov标识符NCT01288651）
