Marques Pedro, Vasques-Nóvoa Francisco, Matias Paula, Vieira Joana T, Mavrakanas Thomas A, Sharma Abhinav, Friões Fernando, Ferreira João Pedro
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.
Clin Res Cardiol. 2024 Oct 21. doi: 10.1007/s00392-024-02557-5.
Intravenous iron improves symptoms in heart failure (HF) with iron deficiency (ID) but failed to consistently show a benefit in cardiovascular outcomes. The ID definition used may influence the response to intravenous iron. The aim of this meta-analysis is to assess the influence of ID definition on the intravenous iron effect in HF.
METHODS/RESULTS: We performed a random-effects meta-analysis of randomized controlled trials (RCT) on intravenous iron (vs. placebo or standard of care) in patients with HF and ID that provided data on transferrin saturation (TSAT) and ferritin subgroups on the composite outcome of cardiovascular death (CVD) or HF hospitalizations (HFH). The risk ratio (RR) and 95% confidence intervals (95% CI) were extracted on the TSAT (< 20% and ≥ 20%) and ferritin (< 100 ng/mL and ≥ 100 ng/mL) subgroups. Data from four major RCT was collected including a total of more than 5500 patients. In patients with a TSAT < 20%, intravenous iron reduced the composite outcome of CVD or HFH: RR 0.81, 95%CI 0.69-0.94, while in patients with a TSAT ≥ 20% the effect was neutral: RR 0.98, 95%CI 0.79-1.21, interaction, P = 0.05. On the other hand, ferritin levels did not modify the effect of IV iron: ferritin ≥ 100 ng/mL RR 0.84, 95%CI 0.65-1.09, and ferritin < 100 ng/mL RR 0.85, 95%CI 0.74-0.97; interaction, P = 0.96.
Our meta-analysis suggests that the benefit of intravenous iron may be restricted to patients with TSAT < 20% regardless of ferritin levels and supports the single use of TSAT < 20% to identify patients with ID who may benefit from intravenous iron therapy.
静脉补铁可改善缺铁性心力衰竭（HF）患者的症状，但在心血管结局方面未能始终显示出益处。所采用的缺铁定义可能会影响对静脉补铁的反应。本荟萃分析的目的是评估缺铁定义对心力衰竭患者静脉补铁效果的影响。
方法/结果：我们对心力衰竭和缺铁患者进行静脉补铁（与安慰剂或标准治疗相比）的随机对照试验（RCT）进行了随机效应荟萃分析，这些试验提供了转铁蛋白饱和度（TSAT）和铁蛋白亚组中心血管死亡（CVD）或心力衰竭住院（HFH）复合结局的数据。在TSAT（<20%和≥20%）和铁蛋白（<100 ng/mL和≥100 ng/mL）亚组中提取风险比（RR）和95%置信区间（95%CI）。收集了四项主要RCT的数据，总共包括5500多名患者。在TSAT<20%的患者中，静脉补铁降低了CVD或HFH的复合结局：RR 0.81，95%CI 0.69 - 0.94，而在TSAT≥20%的患者中，效果为中性：RR 0.98，95%CI 0.79 - 1.21，交互作用，P = 0.05。另一方面，铁蛋白水平并未改变静脉补铁的效果：铁蛋白≥100 ng/mL时RR 0.84，95%CI 0.65 - 1.09，铁蛋白<100 ng/mL时RR 0.85，95%CI 0.74 - 0.97；交互作用，P = 0.96。
我们的荟萃分析表明，无论铁蛋白水平如何，静脉补铁的益处可能仅限于TSAT<20%的患者，并支持仅使用TSAT<20%来识别可能从静脉补铁治疗中获益的缺铁患者。
