Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal.
Department of Surgery and Physiology, Cardiovascular Research and Development Center (UnIC@RISE), Faculty of Medicine of the University of Porto, Porto, Portugal.
Eur J Heart Fail. 2023 Dec;25(12):2191-2198. doi: 10.1002/ejhf.2992. Epub 2023 Aug 24.
Intravenous (IV) iron increases haemoglobin/haematocrit and improves outcomes in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) also increase haemoglobin/haematocrit and improve outcomes in heart failure by mechanisms linked to nutrient deprivation signalling and reduction of inflammation and oxidative stress. The effect of IV iron among patients using SGLT2i has not yet been studied. The aim of this study was to evaluate the changes in haemoglobin, haematocrit, and iron biomarkers in HFrEF patients treated with IV iron with and without background SGLT2i treatment. Secondary outcomes included changes in natriuretic peptides, kidney function and heart failure-associated outcomes.
Retrospective, single-centre analysis of HFrEF patients with iron deficiency treated with IV iron using (n = 60) and not using (n = 60) SGLT2i, matched for age and sex. Mean age was 73 ± 12 years, 48% were men, with more than 65% of patients having chronic kidney disease and anaemia. After adjustment for all baseline differences, SGLT2i users experienced a greater increase in haemoglobin and haematocrit compared to SGLT2i non-users: haemoglobin +0.57 g/dl (95% confidence interval [CI] 0.04-1.10, p = 0.036) and haematocrit +1.64% (95% CI 0.18-3.11, p = 0.029). No significant differences were noted for iron biomarkers or any of the secondary outcomes.
Combined treatment with IV iron and background SGLT2i was associated with a greater increase in haemoglobin and haematocrit than IV iron without background SGLT2i. These results suggest that in HFrEF patients treated with IV iron, SGLT2i may increase the erythropoietic response. Further studies are needed to ascertain the potential benefit or harm of combining these two treatments in heart failure patients.
静脉（IV）铁剂可增加血红蛋白/血细胞比容，并改善射血分数降低的心力衰竭（HFrEF）伴缺铁患者的结局。钠-葡萄糖共转运蛋白 2 抑制剂（SGLT2i）也可通过与营养剥夺信号相关的机制增加血红蛋白/血细胞比容，并通过减少炎症和氧化应激改善心力衰竭的结局。目前尚未研究 SGLT2i 使用者中 IV 铁的作用。本研究旨在评估 HFrEF 伴缺铁患者接受 IV 铁剂治疗时合并或不合并背景 SGLT2i 治疗后血红蛋白、血细胞比容和铁生物标志物的变化。次要结局包括利钠肽、肾功能和心力衰竭相关结局的变化。
回顾性分析了在单中心使用 IV 铁剂治疗的 HFrEF 伴缺铁患者（n=60）和未使用 IV 铁剂治疗的患者（n=60）的资料，这些患者按年龄和性别进行匹配。平均年龄为 73±12 岁，48%为男性，超过 65%的患者患有慢性肾脏病和贫血。在调整所有基线差异后，与 SGLT2i 非使用者相比，SGLT2i 使用者的血红蛋白和血细胞比容增加更为显著：血红蛋白增加 0.57g/dl（95%置信区间 [CI] 0.04-1.10，p=0.036）和血细胞比容增加 1.64%（95% CI 0.18-3.11，p=0.029）。铁生物标志物或任何次要结局均无显著差异。
与 IV 铁剂无背景治疗相比，IV 铁剂联合背景 SGLT2i 治疗与血红蛋白和血细胞比容的增加更为显著。这些结果表明，在接受 IV 铁剂治疗的 HFrEF 患者中，SGLT2i 可能会增加促红细胞生成反应。需要进一步的研究来确定在心力衰竭患者中联合使用这两种治疗方法的潜在益处或危害。
