静脉注射羧基麦芽糖铁对右心室功能的影响——来自 IRON-CRT 试验的见解。
The effect of intravenous ferric carboxymaltose on right ventricular function - insights from the IRON-CRT trial.
机构信息
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
出版信息
Eur J Heart Fail. 2022 Jun;24(6):1106-1113. doi: 10.1002/ejhf.2489. Epub 2022 Mar 28.
AIMS
Ferric carboxymaltose (FCM) improves left ventricular function in heart failure with reduced ejection fraction (HFrEF). Yet, the effect of FCM on right ventricular (RV) function remains insufficiently elucidated.
METHODS AND RESULTS
This is a pre-defined analysis of the IRON-CRT trial in which symptomatic HFrEF patients with iron deficiency and reduced left ventricular ejection fraction (LVEF) despite optimal medical therapy and cardiac resynchronization therapy (CRT) underwent 1:1 randomization to FCM or placebo in a double-blind fashion. RV function was measured as the change from baseline to 3-month follow-up in RV fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE) and pulsed Doppler peak velocity at the RV lateral annulus (RV S'), systolic pulmonary artery pressure (SPAP) and its coupling to the right ventricle (TAPSE/SPAP ratio). The RV contractile reserve was measured as the change in TAPSE during incremental pacing at 70, 90 and 110 bpm. A total of 75 patients underwent randomization and received FCM (n = 37) or placebo (n = 38). At baseline 72.5% had RV dysfunction and 70% had RV dilatation. At 3-month follow-up, patients receiving FCM had a significant improvement in RV FAC (+4.1% [+1.4% - +6.9%] vs. -2.2% [-4.9% - +0.6%] in the placebo group, p = 0.002) and TAPSE (+0.98 mm [+0.28 mm - +1.62 mm] vs. -0.19 mm [-0.85 mm - +0.48 mm] in the placebo group, p = 0.020), but not RV S'. Patients receiving FCM had a numerically lower SPAP (p = 0.073) and significant improvement in TAPSE/SPAP ratio (+0.097 [+0.048 - +0.146] vs. +0.002 [-0.046 - +0.051] in the placebo group, p = 0.008). At baseline both groups had diminished RV contractile reserve during incremental pacing, which was attenuated at 3-month follow-up in the FCM group (p = 0.004). Patients manifesting more RV function improvement were more likely to exhibit higher degrees of LVEF improvement (p < 0.05 for all).
CONCLUSIONS
Treatment with FCM in HFrEF patients results in an improvement in RV function and structure and improves the RV contractile reserve.
目的
铁羧麦芽糖（FCM）可改善射血分数降低的心力衰竭（HFrEF）患者的左心室功能。然而，FCM 对右心室（RV）功能的影响仍未得到充分阐明。
方法和结果
这是对 IRON-CRT 试验的预先设定分析，该试验中，尽管接受了最佳药物治疗和心脏再同步治疗（CRT），但仍存在铁缺乏和左心室射血分数（LVEF）降低的症状性 HFrEF 患者以 1:1 的比例随机分为 FCM 或安慰剂组，进行双盲治疗。RV 功能通过 RV 局部面积变化（FAC）、三尖瓣环平面收缩期位移（TAPSE）和 RV 外侧环脉冲多普勒峰值速度（RV S'）从基线到 3 个月随访的变化来测量，测量肺动脉收缩压（SPAP）及其与右心室的耦合（TAPSE/SPAP 比值）。RV 收缩储备通过在 70、90 和 110 bpm 时递增起搏时 TAPSE 的变化来测量。共有 75 名患者接受了随机分组，并接受了 FCM（n=37）或安慰剂（n=38）治疗。基线时，72.5%的患者存在 RV 功能障碍，70%的患者存在 RV 扩张。在 3 个月的随访中，接受 FCM 的患者 RV FAC 显著改善（+4.1%[+1.4%至+6.9%]与安慰剂组的-2.2%[-4.9%至+0.6%]相比，p=0.002）和 TAPSE（+0.98mm[+0.28mm 至+1.62mm]与安慰剂组的-0.19mm[-0.85mm 至+0.48mm]相比，p=0.020），但 RV S'没有改善。接受 FCM 的患者的 SPAP 数值较低（p=0.073），TAPSE/SPAP 比值显著改善（+0.097[+0.048 至+0.146]与安慰剂组的+0.002[+0.046 至+0.051]相比，p=0.008）。在基线时，两组在递增起搏时 RV 收缩储备均降低，而在 FCM 组，这种降低在 3 个月的随访中得到了缓解（p=0.004）。RV 功能改善更明显的患者更有可能表现出更高程度的 LVEF 改善（p<0.05 均）。
结论
在 HFrEF 患者中使用 FCM 治疗可改善 RV 功能和结构，并改善 RV 收缩储备。
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