Ramos-Polo Raúl, Ras-Jiménez Maria Del Mar, Basalo Carbajales María Del Carmen, Jovells-Vaqué Sílvia, Garcia-Pinilla José Manuel, Cobo-Marcos Marta, de Juan-Bagudá Javier, Fonseca Cândida, Francesch Manzano Josep, Cosa Andreea Eunice, Yun-Viladomat Sergi, Enjuanes Cristina, Tajes Orduña Marta, Comin-Colet Josep
Cardiology Department, Heart Institute, Bellvitge University Hospital, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08908 Barcelona, Spain.
J Clin Med. 2025 Jun 7;14(12):4048. doi: 10.3390/jcm14124048.
Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to ID may lead to cardiac function abnormalities, that can be reversible after iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW) and its derivatives constructive work (CW), wasted work (WW) and work efficiency (WE), may be of added value in advanced cardiac performance assessment. : IRON-PATH II was a multicenter, prospective and observational study designed to describe the pathophysiological pathways associated with ID. The echo-substudy included 100 HF patients that had undergone a specific pilot echocardiographic evaluation. Patients had a left ventricular ejection fraction (LVEF) ≤50%, were in stable clinical condition and on standard HF medication with hemoglobin ≥11 g/dL. The final cohort included 98 patients. : The ID group showed worse cardiac function, with lower GLS (-8.5 ± 9% vs. -10 ± 10%), WE (74 ± 10% vs. 80 ± 10%) and MW (665 [453-1013] vs. 947 [542-1199] mmHg%), as well as higher WW (290 [228-384] vs. 212 [138-305] mmHg%) and lower RV free wall strain (-13 [-20-(-11)]% vs. -17 [-23-(-14)]%). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all -values >0.05 compared to the non-ID group). : Among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV. All the alterations seen were reversible after intravenous iron repletion.
缺铁（ID）是心力衰竭（HF）患者中常见的合并症。它常与预后不良和身体能力受损相关。与ID相关的功能限制可能导致心功能异常。与ID相关的功能限制可能导致心功能异常，铁补充后这种异常可能可逆。一些超声心动图参数，如整体纵向应变（GLS）、心肌做功（MW）及其衍生的建设性做功（CW）、无用功（WW）和做功效率（WE），在高级心脏功能评估中可能具有附加价值。IRON-PATH II是一项多中心、前瞻性观察性研究，旨在描述与ID相关的病理生理途径。超声心动图亚研究纳入了100例接受过特定超声心动图初步评估的HF患者。患者左心室射血分数（LVEF）≤50%，临床状况稳定，接受标准HF药物治疗，血红蛋白≥11 g/dL。最终队列包括98例患者。ID组的心功能较差，GLS较低（-8.5±9%对-10±10%）、WE较低（74±10%对80±10%）、MW较低（665[453 - 1013]对947[542 - 1199]mmHg%），WW较高（290[228 - 384]对212[138 - 305]mmHg%），右室游离壁应变较低（-13[-20 - (-11)]%对-17[-23 - (-14)]%）。铁补充后，ID患者的左心室（GLS、MW、WE和WW）和右心室功能（右室游离壁应变）得到改善，与非ID患者相当（与非ID组相比，所有p值>0.05）。在LVEF降低的HF患者中，ID与左、右心室心肌功能较差相关。静脉补铁后，所有观察到的改变均可逆转。
