Institute of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
Institute of Heart Diseases, University Hospital, Wroclaw, Poland.
Curr Heart Fail Rep. 2023 Aug;20(4):300-307. doi: 10.1007/s11897-023-00611-3. Epub 2023 Jul 10.
Iron deficiency (ID) complicates heart failure (HF) at different stages of the natural history of the disease; however, this frequent comorbidity is still not comprehensively understood and investigated in terms of pathophysiology. Intravenous iron therapy with ferric carboxymaltose (FCM) should be considered to improve the quality of life, exercise capacity, and symptoms in stable HF with ID, as well as to reduce HF hospitalizations in iron-deficient patients stabilized after an episode of acute HF. The therapy with intravenous iron, however, continues to generate important clinical questions for cardiologists.
In the current paper, we discuss the class effect concept for intravenous iron formulations beyond FCM, based on the experiences of nephrologists who administer different intravenous iron formulations in advanced chronic kidney disease complicated with ID and anemia. Furthermore, we discuss the neutral effects of oral iron therapy in patients with HF, because there are still some reasons to further explore this route of supplementation. The different definitions of ID applied in HF studies and new doubts regarding possible interactions of intravenous iron with sodium-glucose co-transporter type 2 inhibitors are also emphasized. The experiences of other medical specializations may provide new information on how to optimally replenish iron in patients with HF and ID.
缺铁（ID）在心力衰竭（HF）疾病自然史的不同阶段使病情复杂化；然而，从病理生理学的角度来看，这种常见的合并症仍未得到全面的理解和研究。对于稳定期 ID 的 HF 患者，应考虑使用羧基麦芽糖铁（FCM）进行静脉铁治疗，以改善生活质量、运动能力和症状，并减少因急性 HF 发作而稳定后的铁缺乏患者的 HF 住院次数。然而，静脉铁治疗仍为心脏病专家带来了许多重要的临床问题。
在目前的论文中，我们根据肾病学家在合并 ID 和贫血的晚期慢性肾脏病患者中使用不同静脉铁制剂的经验，讨论了除 FCM 以外的静脉铁制剂的类别效应概念。此外，我们还讨论了 HF 患者口服铁治疗的中性作用，因为仍有一些原因需要进一步探索这种补充途径。HF 研究中应用的不同 ID 定义以及关于静脉铁与钠-葡萄糖共转运蛋白 2 抑制剂可能存在相互作用的新疑虑也被强调。其他医学专业的经验可能为如何优化 HF 和 ID 患者的铁补充提供新信息。
