Hospital Amadora-Sintra, Lisbon, Portugal.
Department of Internal Medicine, Hospital Santa Maria/CHLN, Lisbon, Portugal; Faculty of Medicine, University of Lisbon, Lisbon, Portugal.
J Am Coll Cardiol. 2018 Feb 20;71(7):782-793. doi: 10.1016/j.jacc.2017.12.027.
Heart failure (HF) is highlighted by its burdening symptom-limited exercise capacity and recurrent hospitalizations. Despite substantial advances regarding disease-modifying drugs in HF with reduced ejection fraction, additional therapeutic strategies to improve quality of life are invaluable. Currently, iron deficiency (ID) is overwhelmingly recognized in over 30% to 50% of patients with stable chronic HF, which worsens prognosis. The established pathophysiological mechanisms of progressive HF may be intertwined with increasing myocardial iron scarcity, wherein one begets the other. Most importantly, ID constitutes a novel target for symptom relief in carefully selected patients. In this regard, intravenous iron may be a safe and efficacious intervention, potentially reducing HF hospitalizations. We discuss the evidence and gaps in knowledge concerning iron therapy in HF and propose a practical, comprehensive, clinically oriented algorithm for timely adequate iron replenishment in different clinical scenarios. Finally, we further debate imperative decision-making before intervention and the drawbacks of such a strategy.
心力衰竭（HF）的特征是症状受限的运动能力和反复住院。尽管在射血分数降低的心力衰竭疾病修饰药物方面取得了重大进展，但改善生活质量的其他治疗策略是非常宝贵的。目前，稳定型慢性心力衰竭患者中超过 30%至 50%的患者存在铁缺乏（ID），这会使预后恶化。不断进展的心力衰竭的既定病理生理机制可能与心肌铁缺乏的逐渐增加交织在一起，相互影响。最重要的是，ID 构成了精心挑选的患者缓解症状的一个新靶点。在这方面，静脉铁可能是一种安全有效的干预措施，有可能减少心力衰竭住院。我们讨论了心力衰竭中铁治疗的证据和知识差距，并提出了一种实用、全面、以临床为导向的算法，用于在不同临床情况下及时充分补充铁。最后，我们进一步讨论了干预前的重要决策和这种策略的缺点。
