British Heart Foundation Centre of Research Excellence, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
Portsmouth Hospitals University NHS Trust, Portsmouth, UK.
Heart. 2024 Sep 25;110(20):1201-1207. doi: 10.1136/heartjnl-2022-322030.
For patients with heart failure and reduced or mildly reduced left ventricular ejection fraction, iron deficiency is common and associated with more severe symptoms, worse quality of life and an increased risk of hospitalisations and death. Iron deficiency can be swiftly, effectively and safely treated by administering intravenous iron, either as ferric carboxymaltose or ferric derisomaltose, which improves patient well-being and reduces the risk of hospitalisations including those for heart failure. However, the current definition of iron deficiency in heart failure has serious flaws. A serum ferritin <100 µg/L does not identify patients more likely to respond to intravenous iron. In contrast, patients with transferrin saturations <20%, most of whom are also anaemic, are more likely to have a beneficial response to intravenous iron. In this review, we summarise the available evidence for use of intravenous iron in heart failure and provide recommendations for targeted future research and practical considerations for the general cardiologist.
对于射血分数降低或轻度降低的心力衰竭患者，铁缺乏很常见，且与更严重的症状、更差的生活质量以及住院和死亡风险增加相关。静脉铁治疗（例如羧基麦芽糖铁或去铁胺麦芽糖铁）可迅速、有效且安全地治疗铁缺乏，改善患者的健康状况，并降低住院风险，包括心力衰竭住院风险。然而，目前心力衰竭中铁缺乏的定义存在严重缺陷。血清铁蛋白 <100μg/L 并不能识别更有可能对静脉铁治疗有反应的患者。相比之下，转铁蛋白饱和度 <20%的患者（其中大多数也贫血）更有可能对静脉铁治疗有反应。在这篇综述中，我们总结了静脉铁在心力衰竭中的应用的现有证据，并为有针对性的未来研究和普通心脏病专家的实际考虑提供了建议。
