Nunez Julio, Mollar Anna, Vera-Aviles Mayra, Kabir Syeeda, Shah Akshay, Polzella Paolo, Desborough Michael, Cardells Ingrid, Miñana Gema, Del Canto Irene, Ferreira Vanessa, Piechnik Stefan, Maceira Alicia, Lakhal-Littleton Samira
Hospital Clínico de Valencia, Fundación INCLIVA, Valencia, Spain.
Universidad de Valencia, Valencia, Spain.
Eur J Heart Fail. 2025 Jun 16. doi: 10.1002/ejhf.3730.
Many patients with heart failure (HF) are iron-deficient. Intravenous (IV) iron therapy improves symptoms and reduces hospitalizations for HF. Several mechanisms have been proposed, including myocardial iron repletion. However, it is unknown if serum iron markers predict the extent of this repletion. To address this question, data from two clinical studies that evaluated changes in myocardial iron using cardiac magnetic resonance (CMR) were harnessed.
The Myocardial-IRON trial measured change in myocardial iron, denoted by a decrease in CMR T1 and T2*, at 7 and 30 days after IV ferric carboxymaltose (FCM) in patients with iron deficiency (ID) and HF (n = 53). The STUDY trial measured myocardial and spleen iron at multiple timepoints after FCM in patients with ID without HF (n = 12). In this post-hoc analysis, we examined the association between baseline serum iron markers (transferrin saturation and ferritin) and change in myocardial iron in the weeks after FCM therapy. Changes in spleen iron were also examined, due its role as an intermediary in the redistribution of iron from iron-carbohydrate complexes such as FCM. In patients with or without HF, higher serum ferritin at baseline predicted lower rise in myocardial iron in the weeks after therapy with FCM. In contrast, higher serum ferritin at baseline predicted a greater rise in spleen iron.
These data point towards the hypothesis that functional ID, which is characterized by elevated ferritin, could limit myocardial iron repletion after IV iron therapy, by favouring iron trapping in the spleen.
许多心力衰竭（HF）患者存在缺铁情况。静脉铁剂治疗可改善症状并减少HF患者的住院次数。已提出多种机制，包括心肌铁补充。然而，血清铁标志物是否能预测这种补充的程度尚不清楚。为解决这个问题，我们利用了两项使用心脏磁共振（CMR）评估心肌铁变化的临床研究数据。
心肌铁试验测量了缺铁（ID）和HF患者（n = 53）静脉注射羧麦芽糖铁（FCM）后7天和30天时心肌铁的变化，以CMR T1和T2 *的降低表示。研究试验测量了无HF的ID患者（n = 12）在FCM治疗后多个时间点的心肌和脾脏铁含量。在这项事后分析中，我们研究了基线血清铁标志物（转铁蛋白饱和度和铁蛋白）与FCM治疗后数周内心肌铁变化之间的关联。由于脾脏铁在铁 - 碳水化合物复合物（如FCM）中铁再分布过程中起中介作用，因此也对其变化进行了研究。在有或无HF的患者中，基线时较高的血清铁蛋白预示着FCM治疗后数周内心肌铁升高幅度较低。相反，基线时较高的血清铁蛋白预示着脾脏铁升高幅度更大。
这些数据支持这样一种假设，即功能性ID（以铁蛋白升高为特征）可能通过促进铁在脾脏中的蓄积来限制静脉铁剂治疗后心肌铁的补充。
