文献检索，用中文搜 PubMed

AIMS

Intravenous iron therapy (IVIT) is known to improve functional status in chronic heart failure (CHF) patients. The exact mechanism is not completely understood. We correlated magnetic resonance imaging (MRI) patterns of T2* iron signal in various organs to systemic iron and exercise capacity (EC) in CHF before and after IVIT.

METHODS AND RESULTS

We prospectively analysed 24 patients with systolic CHF for T2* MRI pattern of the left ventricle (LV), small and large intestines, spleen, liver, skeletal muscle, and brain for iron. In 12 patients with iron deficiency (ID), we restored iron deficit by IVIT using ferric carboxymaltose. The effects after 3 months were analysed by spiroergometry and MRI. Patients with vs. without ID showed lower blood ferritin, haemoglobin (76 ± 63 vs. 196 ± 82 μg/L and 12.3 ± 1.1 vs. 14.2 ± 1.1 g/dL, all P < 0.002), and in trend a lower transferrin saturation (TSAT) (19.1 [13.1; 28.2] vs. 25.1 [21.3; 29.1] %, P = 0.05). Spleen and liver iron was lower as expressed by higher T2* value (71.8 [66.4; 93.1] vs. 36.9 [32.9; 51.7] ms, P < 0.002 and 33.5 ± 5.9 vs. 28.8 ± 3.9 ms, and P < 0.03). There was a strong trend for a lower cardiac septal iron content in ID (40.6 [33.0; 57.3] vs. 33.7 [31.3; 40.2] ms, P = 0.07). After IVIT, ferritin, TSAT, and haemoglobin increased (54 [30; 104] vs. 235 [185; 339] μg/L, 19.1 [13.1; 28.2] vs. 25.0 [21.0; 33.7] %, 12.3 ± 1.1 vs. 13.3 ± 1.3 g/L, all P < 0.04). Peak VO improved (18.2 ± 4.2 vs. 20.9 ± 3.8 mL/min/kg , P = 0.05). Higher peak VO at anaerobic threshold was associated with higher blood ferritin, reflecting higher metabolic exercise capacity after therapy (r = 0.9, P = 0.0009). Increase in EC was associated with haemoglobin increase (r = 0.7, P = 0.034). LV iron increased by 25.4% (48.5 [36.2; 64.8] vs. 36.2 [32.9; 41.9] ms, P < 0.04). Spleen and liver iron increased by 46.4 and 18.2%, respectively (71.8 [66.4; 93.1] vs. 38.5 [22.4; 76.9] ms, P < 0.04 and 33.5 ± 5.9 vs. 27.4 ± 8.6 ms, P < 0.007). Iron in skeletal muscle, brain, intestine, and bone marrow remained unchanged (29.6 [28.6; 31.2] vs. 30.4 [29.7; 30.7] ms, P = 0.7, 81.0 ± 6.3 vs. 82.9 ± 9.9 ms, P = 0.6, 34.3 ± 21.4 vs. 25.3 ± 14.1 ms, P = 0.2, 9.4 [7.5; 21.8] vs. 10.3 [6.7; 15.7] ms, P = 0.5 and 9.8 ± 1.5 vs. 13.7 ± 8.9 ms, P = 0.1).

CONCLUSIONS

CHF patients with ID showed lower spleen, liver, and in trend lower cardiac septal iron. After IVIT, iron signal of the left ventricle as well as spleen and liver increased. Improvement in EC was associated with increase in haemoglobin after IVIT. In ID, liver, spleen, and brain but not heart iron were associated with markers of systemic ID.

AIMS

METHODS AND RESULTS

CONCLUSIONS

目的

静脉铁治疗（IVIT）已知可改善慢性心力衰竭（CHF）患者的功能状态。确切的机制尚不完全清楚。我们将铁磁共振成像（MRI）T2*铁信号的各种器官模式与 CHF 患者 IVIT 前后的系统铁和运动能力（EC）相关联。

方法和结果

我们前瞻性地分析了 24 例收缩性 CHF 患者的左心室（LV）、小肠、大肠、脾脏、肝脏、骨骼肌和大脑的 T2* MRI 模式。在 12 例缺铁（ID）患者中，我们使用羧基麦芽糖铁通过 IVIT 来纠正缺铁。在 3 个月后通过测功计和 MRI 分析效果。与 ID 患者相比，无 ID 患者的血铁蛋白、血红蛋白（76±63 vs. 196±82μg/L 和 12.3±1.1 vs. 14.2±1.1g/dL，均 P<0.002）和转铁饱和度（TSAT）较低（19.1[13.1; 28.2] vs. 25.1[21.3; 29.1]%，P=0.05）。脾脏和肝脏铁的 T2*值较高，表明铁含量较低（71.8[66.4; 93.1] vs. 36.9[32.9; 51.7]ms，P<0.002 和 33.5±5.9 vs. 28.8±3.9ms，P<0.03）。ID 患者的心脏间隔铁含量也有较低的趋势（40.6[33.0; 57.3] vs. 33.7[31.3; 40.2]ms，P=0.07）。IVIT 后，铁蛋白、TSAT 和血红蛋白升高（54[30; 104] vs. 235[185; 339]μg/L，19.1[13.1; 28.2] vs. 25.0[21.0; 33.7]%，12.3±1.1 vs. 13.3±1.3g/L，均 P<0.04）。峰值 VO 改善（18.2±4.2 vs. 20.9±3.8mL/min/kg，P=0.05）。更高的无氧阈峰值 VO 与更高的血铁蛋白相关，反映出治疗后更高的代谢运动能力（r=0.9，P=0.0009）。EC 的增加与血红蛋白的增加相关（r=0.7，P=0.034）。LV 铁增加了 25.4%（48.5[36.2; 64.8] vs. 36.2[32.9; 41.9]ms，P<0.04）。脾脏和肝脏铁分别增加了 46.4%和 18.2%（71.8[66.4; 93.1] vs. 38.5[22.4; 76.9]ms，P<0.04 和 33.5±5.9 vs. 27.4±8.6ms，P<0.007）。骨骼肌、大脑、肠道和骨髓中的铁含量保持不变（29.6[28.6; 31.2] vs. 30.4[29.7; 30.7]ms，P=0.7，81.0±6.3 vs. 82.9±9.9ms，P=0.6，34.3±21.4 vs. 25.3±14.1ms，P=0.2，9.4[7.5; 21.8] vs. 10.3[6.7; 15.7]ms，P=0.5 和 9.8±1.5 vs. 13.7±8.9ms，P=0.1）。