心力衰竭中的缺铁及其对达格列净的影响：来自 DAPA-HF 的研究结果。
Iron Deficiency in Heart Failure and Effect of Dapagliflozin: Findings From DAPA-HF.
机构信息
British Heart Foundation Cardiovascular Research Centre, University of Glasgow, United Kingdom (K.F.D., P.W., N.S., P.S.J., J.J.V.M.).
Division of Cardiac Surgery, St Michael's Hospital, University of Toronto, Canada (S.V.).
出版信息
Circulation. 2022 Sep 27;146(13):980-994. doi: 10.1161/CIRCULATIONAHA.122.060511. Epub 2022 Aug 16.
BACKGROUND
Iron deficiency is common in heart failure and associated with worse outcomes. We examined the prevalence and consequences of iron deficiency in the DAPA-HF trial (Dapagliflozin and Prevention of Adverse-Outcomes in Heart Failure) and the effect of dapagliflozin on markers of iron metabolism. We also analyzed the effect of dapagliflozin on outcomes, according to iron status at baseline.
METHODS
Iron deficiency was defined as a ferritin level <100 ng/mL or a transferrin saturation <20% and a ferritin level 100 to 299 ng/mL. Additional biomarkers of iron metabolism, including soluble transferrin receptor, erythropoietin, and hepcidin were measured at baseline and 12 months after randomization. The primary outcome was a composite of worsening heart failure (hospitalization or urgent visit requiring intravenous therapy) or cardiovascular death.
RESULTS
Of the 4744 patients randomized in DAPA-HF, 3009 had ferritin and transferrin saturation measurements available at baseline, and 1314 of these participants (43.7%) were iron deficient. The rate of the primary outcome was higher in patients with iron deficiency (16.6 per 100 person-years) compared with those without (10.4 per 100 person-years; <0.0001). The effect of dapagliflozin on the primary outcome was consistent in iron-deficient compared with iron-replete patients (hazard ratio, 0.74 [95% CI, 0.58-0.92] versus 0.81 [95% CI, 0.63-1.03]; -interaction=0.59). Similar findings were observed for cardiovascular death, heart failure hospitalization, and all-cause mortality. Transferrin saturation, ferritin, and hepcidin were reduced and total iron-binding capacity and soluble transferrin receptor increased with dapagliflozin compared with placebo.
CONCLUSIONS
Iron deficiency was common in DAPA-HF and associated with worse outcomes. Dapagliflozin appeared to increase iron use but improved outcomes, irrespective of iron status at baseline.
REGISTRATION
URL: https://www.
CLINICALTRIALS
gov; Unique identifier: NCT03036124.
背景
铁缺乏在心力衰竭中很常见，并且与更差的结局相关。我们在 DAPA-HF 试验（达格列净预防心力衰竭不良结局）中检查了铁缺乏的患病率和后果，以及达格列净对铁代谢标志物的影响。我们还根据基线时的铁状态分析了达格列净对结局的影响。
方法
铁缺乏定义为铁蛋白水平<100ng/mL 或转铁蛋白饱和度<20%，且铁蛋白水平为 100-299ng/mL。基线和随机分组后 12 个月时还测量了铁代谢的其他生物标志物，包括可溶性转铁蛋白受体、促红细胞生成素和铁调素。主要结局是心力衰竭恶化（住院或需要静脉治疗的紧急就诊）或心血管死亡的复合终点。
结果
在 DAPA-HF 中随机分组的 4744 例患者中，有 3009 例基线时可获得铁蛋白和转铁蛋白饱和度测量值，其中 1314 例（43.7%）患者存在铁缺乏。铁缺乏患者的主要结局发生率较高（每 100 人年 16.6 例），而无铁缺乏患者的发生率较低（每 100 人年 10.4 例；<0.0001）。与铁储备充足的患者相比，铁缺乏患者应用达格列净的主要结局效应一致（风险比，0.74[95%CI，0.58-0.92] 与 0.81[95%CI，0.63-1.03]；-交互作用=0.59）。对于心血管死亡、心力衰竭住院和全因死亡率，也观察到了类似的发现。与安慰剂相比，达格列净降低了转铁蛋白饱和度、铁蛋白和铁调素，增加了总铁结合能力和可溶性转铁蛋白受体。
结论
铁缺乏在 DAPA-HF 中很常见，与更差的结局相关。达格列净似乎增加了铁的利用，但改善了结局，而与基线时的铁状态无关。
登记信息
网址：https://www.
临床试验
gov；独特标识符：NCT03036124。
Zotero 插件