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Tiglis M, Cobilinschi C, Elena Mirea L, Emil Băetu A, Peride I, Paul Neagu T, Niculae A, Alexandru Checherită I, Marina Grintescu I. The Importance of Iron Administration in Correcting Anaemia After Major Surgery. J Crit Care Med (Targu Mures) 2021; 7:184-191. [PMID: 34722921 PMCID: PMC8519388 DOI: 10.2478/jccm-2021-0028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/21/2021] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Postoperative anaemia can affect more than 90% of patients undergoing major surgeries. Patients develop an absolute iron deficiency in the face of significant blood loss or preoperative anaemia and major surgery. Studies have shown the negative impact of these factors on transfusion requirements, infections, increased hospitalisation and long-term morbidities. AIM OF THE STUDY The research was performed to determine the correlation between intravenous iron administration in the postoperative period and improved haemoglobin correction trend. MATERIAL AND METHODS A prospective study was conducted to screen and treat iron deficiency in patients undergoing major surgery associated with significant bleeding. For iron deficiency anaemia screening, in the postoperative period, the following bioumoral parameters were assessed: haemoglobin, serum iron, transferrin saturation (TSAT), and ferritin, direct serum total iron-binding capacity (dTIBC), mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH). In addition, serum glucose, fibrinogen, urea, creatinine and lactate values were also collected. RESULTS Twenty-one patients undergoing major surgeries (52,38% were emergency and 47,61% elective interventions) were included in the study. Iron deficiency, as defined by ferritin 100-300 μg/L along with transferrin saturation (TSAT) < 20 %, mean corpuscular volume (MVC) < 92 fL, mean corpuscular haemoglobin (MCH) < 33 g/dL, serum iron < 10 μmol/L and direct serum total iron-binding capacity (dTIBC) > 36 μmol/L, was identified in all cases. To correct the deficit and optimise the haematological status, all patients received intravenous ferric carboxymaltose (500-1000 mg, single dose). Using Quadratic statistical analysis, the trend of haemoglobin correction was found to be a favourable one. CONCLUSION The administration of intravenous ferric carboxymaltose in the postoperative period showed the beneficial effect of this type of intervention on the haemoglobin correction trend in these groups of patients.
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Affiliation(s)
- Mirela Tiglis
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Cristian Cobilinschi
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Liliana Elena Mirea
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Alexandru Emil Băetu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
| | - Ileana Peride
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Andrei Niculae
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Ioana Marina Grintescu
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Emergency Clinical Hospital of Bucharest, BucharestRomania
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Blumenstein I, Shanbhag S, Langguth P, Kalra PA, Zoller H, Lim W. Newer formulations of intravenous iron: a review of their chemistry and key safety aspects - hypersensitivity, hypophosphatemia, and cardiovascular safety. Expert Opin Drug Saf 2021; 20:757-769. [PMID: 33993818 DOI: 10.1080/14740338.2021.1912010] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: The newest intravenous (IV) iron products show an improved safety profile over predecessors, allowing for the rapid administration of relatively high doses. Ferric derisomaltose (FDI; also known as iron isomaltoside), ferric carboxymaltose (FCM), and ferumoxytol (FER), are successful treatments for iron deficiency (Europe; FDI and FCM) and iron deficiency anemia (US; FDI, FCM, and FER).Areas covered: This review focusses on the chemistry and structure of FDI, FCM, and FER, and on three key aspects of IV iron safety: (1) hypersensitivity; (2) hypophosphatemia and sequelae; (3) cardiovascular safety.Expert opinion: Although the safety of modern IV iron has improved, immediate infusion reactions and the development of hypophosphatemia must be appreciated and recognized by those who prescribe and administer IV iron. Immediate infusion reactions can occur with any IV iron and are usually mild; severe reactions - particularly anaphylaxis - are extremely rare. The recognition and appropriate management of infusion reactions is an important consideration to the successful administration of IV iron. Severe, persistent, hypophosphatemia is a specific side effect of FCM. No cardiovascular safety signal has been identified for IV iron. Ongoing trials in heart failure will provide additional long-term efficacy and safety data.
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Affiliation(s)
- Irina Blumenstein
- Medical Department 1, Department of Gastroenterology, Hepatology, and Clinical Nutrition, University Clinic Frankfurt, Frankfurt, Germany
| | - Satish Shanbhag
- Department of Hematology/Medical Oncology, Cancer Specialists of North Florida, Fleming Island, FL, USA.,Division of Hematology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - Peter Langguth
- Institute of Pharmacy and Biochemistry, Department of Biopharmaceutics and Pharmaceutical Technology, Johannes Gutenberg University, Mainz, Germany
| | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.,Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Heinz Zoller
- Department of Medicine I, Gastroenterology, Hepatology and Endocrinology, Medical University of Innsbruck, Innsbruck, Austria
| | - Wendy Lim
- Department of Medicine, Division of Hematology and Thromboembolism, St. Joseph's Healthcare Hamilton, McMaster University, Hamilton, ON, Canada
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Brautaset Englund KV, Østby CM, Tjønnås G, Gude E, Andreassen AK, Gullestad L, Broch K. Prevalence of iron deficiency in heart transplant recipients. Clin Transplant 2021; 35:e14346. [PMID: 33969559 DOI: 10.1111/ctr.14346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optimal iron management is crucial to marginal patients such as heart transplant recipients. As inflammatory mechanisms are present in transplant recipients, the definition of iron deficiency used in the general population might not be appropriate. OBJECTIVE To evaluate the prevalence and determinants of iron deficiency in Norwegian heart transplant recipients. METHODS We consecutively assessed iron parameters in all Norwegian heart transplant recipients at their annual follow-up. Several definitions of iron deficiency suggested in the literature were assessed: ferritin <100 µg/L, or ferritin 100-300 µg/L combined with transferrin saturation of <20% (IDHF ); ferritin <100 µg/L (IDF100 ); transferrin saturation of <20% (IDTsat ), and ferritin <30 µg/L (IDF30 ). RESULTS 179 of 378 heart transplant recipients (47%) had iron deficiency defined as IDHF . 152 patients (40%) had IDF100 , and 103 patients (27%) had IDTsat . 17 patients (5%) had IDF30 . 88 patients (23%) had a C-reactive protein (CRP) >5.0 µg/L. CONCLUSION Iron deficiency defined as IDHF , IDF100, or IDTsat is prevalent in the heart transplant population, while IDF30 is not. Further research is required to identify the mechanisms of iron homeostasis in heart transplant recipients and to establish a definition of iron deficiency suitable for this population.
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Affiliation(s)
- Kristine V Brautaset Englund
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Gry Tjønnås
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arne K Andreassen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kaspar Broch
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,K.G.Jebsen Cardiac Research Center and Center for Heart Failure Research, Faculty of Medicine, University of Oslo, Oslo, Norway
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Kearney A, Linden K, Savage P, Menown IBA. Advances in Clinical Cardiology 2020: A Summary of Key Clinical Trials. Adv Ther 2021; 38:2170-2200. [PMID: 33844133 PMCID: PMC8040014 DOI: 10.1007/s12325-021-01711-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/12/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Despite the challenge of a global pandemic, 2020 has been an invaluable year in cardiology research with numerous important clinical trials published or presented virtually at major international meetings. This article aims to summarise these trials and place them in clinical context. METHODS The authors reviewed clinical trials presented at major cardiology conferences during 2020 including the American College of Cardiology, European Association for Percutaneous Cardiovascular Interventions, European Society of Cardiology, Transcatheter Cardiovascular Therapeutics and the American Heart Association. Trials with a broad relevance to the cardiology community and those with potential to change current practice were included. RESULTS A total of 87 key cardiology clinical trials were identified for inclusion. New interventional and structural cardiology data included trials evaluating bifurcation percutaneous coronary intervention (PCI) techniques, intravascular ultrasound (IVUS)-guided PCI, instantaneous wave-free (iFR) physiological assessment, new generation stents (DynamX bioadaptor), transcatheter aortic valve implantation (TAVI) in low-risk patients, and percutaneous mitral or tricuspid valve interventions. Preventative cardiology data included new data with proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors (evolocumab and alirocumab), omega-3 supplements, evinacumab and colchicine in the setting of chronic coronary artery disease. Antiplatelet data included trials evaluating both the optimal length of course following PCI and combination of antiplatelet agents and regimes including combination antithrombotic therapies for patients with atrial fibrillation (AF). Heart failure data included the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors (sotagliflozin, empagliflozin and dapagliflozin) and mavacamten in hypertrophic cardiomyopathy. Electrophysiology trials included early rhythm control in AF and screening for AF. CONCLUSION This article presents a summary of key clinical cardiology trials during the past year and should be of relevance to both clinicians and cardiology researchers.
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Affiliation(s)
- Aileen Kearney
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Katie Linden
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Patrick Savage
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK
| | - Ian B A Menown
- Craigavon Cardiac Centre, Southern Health and Social Care Trust, Craigavon, Northern Ireland, UK.
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A paradox: Fe2+-containing agents decreased ROS and apoptosis induced by CoNPs in vascular endothelial cells by inhibiting HIF-1α. Biosci Rep 2021; 41:227394. [PMID: 33345265 PMCID: PMC7796189 DOI: 10.1042/bsr20203456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/27/2020] [Accepted: 12/18/2020] [Indexed: 02/06/2023] Open
Abstract
Cobalt nanoparticles (CoNPs) released from hip joint implants are known to have a toxic effect on several organs probably through increasing reactive oxygen species (ROS). Ferrous ion (Fe2+) is well-known to enhance oxidative stress by catalysing the production of ROS. However, in our pilot study, we found that Fe2+ conversely inhibited the ROS production induced by CoNPs. To elucidate the underlying mechanism, the present study treated vascular endothelial HUVEC and HMEC-1 cells with CoNPs alone or in combination with ferrous lactate [Fe(CH3CHOHCOO)2], ferrous succinate [Fe(CH2COO)2], and ferrous chloride (FeCl2). CoNP toxicity was evaluated by measuring cell viability, rate of apoptosis and lactose dehydrogenase (LDH) release, and intracellular ROS levels. Treatment with CoNPs decreased cell viability, LDH release, and ROS production and increased apoptosis. CoNPs increased hypoxia-inducible factor-1α (HIF-1α) protein level and mRNA levels of vascular endothelial growth factor (VEGF) and glucose transporter 1 (GLUT1) downstream of HIF-1α signalling. Silencing HIF-1α attenuated CoNP toxicity, as seen by recovery of cell viability, LDH release, and ROS levels and reduced apoptosis. CoNPs caused a pronounced reduction of Fe2+ in cells, but supplementation with Fe(CH3CHOHCOO)2, Fe(CH2COO)2, and FeCl2 restored Fe2+ levels and inhibited HIF-1α activation. Moreover, all three Fe2+-containing agents conferred protection from CoNPs; Fe(CH3CHOHCOO)2 and Fe(CH2COO)2 more effectively than FeCl2. In summary, the present study revealed that CoNPs exert their toxicity on human vascular endothelial cells by depleting intracellular Fe2+ level, which causes activation of HIF-1α signalling. Supplements of Fe2+, especially in the form of Fe(CH3CHOHCOO)2 and Fe(CH2COO)2, mitigated CoNP toxicity.
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Delgado JF, Oliva J, González-Franco Á, Cepeda JM, García-García JÁ, González-Domínguez A, Garcia-Casanovas A, Jiménez Merino S, Comín-Colet J. Budget impact of ferric carboxymaltose treatment in patients with chronic heart failure and iron deficiency in Spain. J Med Econ 2020; 23:1418-1424. [PMID: 33073660 DOI: 10.1080/13696998.2020.1838872] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The treatment of iron deficiency (ID) with ferric carboxymaltose (FCM) improves the functional class and quality of life of chronic heart failure (CHF) patients with reduced left ventricular ejection fraction (LVEF), and reduces the rate of hospitalization due to worsening CHF. This study aims to evaluate the budget impact for the Spanish National Health System (SNHS) of treating ID in reduced LVEF CHF with FCM compared to non-iron treatment. METHODS We simulated a hypothetical cohort of 1000 CHF patients with ID and reduced LVEF based on the Spanish population characteristics. A decision-analytic model was also built using the data from the largest FCM clinical trial (CONFIRM-HF) that lasted for a year. We considered the use of healthcare resources from a national prospective study. A deterministic sensitivity analysis was carried out varying the corresponding baseline data by ±25%. RESULTS The cost of treating the simulated population with FCM was €2,570,914, while that of the non-iron treatment was €3,105,711, which corresponds to a cost saving of €534,797 per 1,000 patients in one year. Cost savings were mainly due to a decrease in the number of hospitalizations. All sensitivity analysis showed cost savings for the SNHS. CONCLUSIONS FCM results in an annual cost saving of €534.80 per patient, and would thus be expected to reduce the economic burden of CHF in Spain.
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Affiliation(s)
- Juan F Delgado
- Cardiology Service, Hospital Universitario 12 de Octubre, Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Faculty of Medicine, Complutense University, Madrid, Spain
| | - Juan Oliva
- Department of Economic Analysis, University of Castilla-La Mancha, Toledo, Spain
| | - Álvaro González-Franco
- Department of Internal Medicine, Hospital Universitario Central de Asturias, Asturias, Spain
- Heart Failure and Atrial Fibrillation Group, Spanish Society of Internal Medicine (SEMI)
| | - Jose María Cepeda
- Department of Internal Medicine, Hospital Vega Baja de Orihuela, Alicante, Spain
| | | | | | | | | | - Josep Comín-Colet
- Community Heart Failure Program, Department of Cardiology, Hospital Universitario de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- University of Barcelona, Barcelona, Spain
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Țigliș M, Neagu TP, Niculae A, Lascăr I, Grințescu IM. Incidence of Iron Deficiency and the Role of Intravenous Iron Use in Perioperative Periods. MEDICINA-LITHUANIA 2020; 56:medicina56100528. [PMID: 33053625 PMCID: PMC7601561 DOI: 10.3390/medicina56100528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 01/01/2023]
Abstract
Iron deficiency is a major problem in worldwide populations, being more alarming in surgical patients. In the presence of absolute iron deficiency (depletion of body iron), functional iron deficiency (during intense bone marrow stimulation by endogenous or exogenous factors), or iron sequestration (acute or chronic inflammatory conditions), iron-restricted erythropoiesis can develop. This systemic review was conducted to draw attention to the delicate problem of perioperative anemia, and to provide solutions to optimize the management of anemic surgical patients. Systemic reviews and meta-analyses, clinical studies and trials, case reports and international guidelines were studied, from a database of 50 articles. Bone marrow biopsy, serum ferritin levels, transferrin saturation, the mean corpuscular volume, and mean corpuscular hemoglobin concentration were used in the diagnosis of iron deficiency. There are various intravenous iron formulations, with different pharmacological profiles used for restoring iron. In surgical patients, anemia is an independent risk factor for morbidity and mortality. Therefore, anemia correction should be rapid, with parenteral iron formulations—the oral ones—being inefficient. Various studies showed the safety and efficacy of parenteral iron formulations in correcting hemoglobin levels and decreasing the blood transfusion rate, the overall mortality, the postoperative infections incidence, hospitalization days, and the general costs.
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Affiliation(s)
- Mirela Țigliș
- Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (M.Ț.); (I.M.G.)
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Tiberiu Paul Neagu
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania;
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Correspondence:
| | - Andrei Niculae
- Department of Nephrology and Dialysis, “St. John” Emergency Clinical Hospital, 042122 Bucharest, Romania;
- Clinical Department No. 3, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioan Lascăr
- Department of Plastic Surgery and Reconstructive Microsurgery, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania;
- Clinical Department No. 11, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ioana Marina Grințescu
- Department of Anaesthesiology and Intensive Care, Emergency Clinical Hospital of Bucharest, 014461 Bucharest, Romania; (M.Ț.); (I.M.G.)
- Clinical Department No. 14, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Terada K, Sakai Y, Sumi Y, Mugishima K, Kawasaki S, Itagaki F, Yamada T, Tsuruoka S. Prognostic markers of heart failure in patients undergoing peritoneal dialysis. RENAL REPLACEMENT THERAPY 2019. [DOI: 10.1186/s41100-019-0231-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Zdravkovic SC, Nagorni SP, Cojbasic I, Mitic V, Cvetkovic P, Nagorni I, Govedarovic N, Davinic I, Stanojevic D. Effects of 6-months of oral ferrous and ferric supplement therapy in patients who were hospitalized for decompensated chronic heart failure. J Int Med Res 2019; 47:3179-3189. [PMID: 31189356 PMCID: PMC6683923 DOI: 10.1177/0300060519847352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Accepted: 04/08/2019] [Indexed: 12/18/2022] Open
Abstract
Objective Anemia is common in patients with chronic heart failure (CHF). This study aimed to examine the frequency of iron deficiency anemia in patients with CHF. We investigated the effects of oral ferrous or ferric supplementation on prognosis of CHF and quality of life. Methods A total of 201 patients with chronic decompensated heart failure were enrolled in a 6-month prospective study. Patients were randomly assigned to two groups. Patients in group I (n = 100) received ferrous fumarate and those in group II (n = 101) received ferric hydroxide polymaltose complex. Quality of life was measured by the 6-minute walking test (6MWT). Results A total of 49% of the patients had iron-dependent anemia in group I and 53.3% were anemic in group II. In group I, the number of anemic patients was significantly lower at 6 months after admission compared with at initial admission (49% versus 45%). Significant improvements were observed in hemoglobin values, the 6MWT distance, and New York Heart Association class after 6 months in both groups. Conclusions Iron deficiency is a significant comorbidity in CHF, even without anemia. Iron should be replaced orally or intravenously because it significantly improves the quality of life of patients.
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Affiliation(s)
- Snezana Ciric Zdravkovic
- Medical Faculty, University of Nis, Nis, Serbia
- Clinic for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia
| | | | - Irena Cojbasic
- Medical Faculty, University of Nis, Nis, Serbia
- Clinic for Hematology, Clinical Center Nis, Nis, Serbia
| | - Vesna Mitic
- Clinic for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia
| | - Predrag Cvetkovic
- Clinic for Cardiovascular Diseases, Clinical Center Nis, Nis, Serbia
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Abstract
PURPOSE OF REVIEW Several novel therapeutics being tested in patients with heart failure are based on myocardial energetics. This review will provide a summary of the recent trials in this area, including therapeutic options targeting various aspects of cellular and mitochondrial metabolism. RECENT FINDINGS Agents that improve the energetic balance in myocardial cells have the potential to improve clinical heart failure status. The most promising therapies currently under investigation in this arena include (1) elamipretide, a cardiolipin stabilizer; (2) repletion of iron deficiency with intravenous ferrous carboxymaltose; (3) coenzyme Q10; and (4) the partial adenosine receptor antagonists capadenoson and neladenosone. Myocardial energetics-based therapeutics are groundbreaking in that they utilize novel mechanisms of action to improve heart failure symptoms, without causing the adverse neurohormonal side effects associated with current guideline-based therapies. The drugs appear likely to be added to the heart failure therapy armamentarium as adjuncts to current regimens in the near future.
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Affiliation(s)
- Kunal N Bhatt
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 1365 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Javed Butler
- Department of Medicine, University of Mississippi School of Medicine, Jackson, MS, USA
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Abstract
PURPOSE OF REVIEW This review will highlight the frequency and prognostic importance of iron deficiency in patients with chronic heart failure. An overview of the evidence surrounding the use of both oral and intravenous iron will be presented together with discussion around what further data are required to establish what is the optimal long-term treatment strategy. RECENT FINDINGS Several recent randomised controlled studies have suggested that intravenous iron therapy in iron deficient patients with chronic heart failure and reduced ejection fraction can improve symptoms and quality of life, at least in the short term. There is no evidence of benefit from oral iron. Iron deficiency is common in patients with chronic heart failure and is associated with a worse prognosis. Whilst oral iron therapy has been shown to be of no benefit, randomised controlled trials suggest significant improvement in symptoms and quality of life with intravenous iron treatment over 6-12 months. Data are lacking on long-term efficacy, safety and impact on hard outcomes such as death and hospitalisation. Four large trials are currently recruiting patients and will provide definitive answers to these outstanding questions.
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Xu L, Chen Y, Ji Y, Yang S. Influencing factors of NT-proBNP level inheart failure patients with different cardiacfunctions and correlation with prognosis. Exp Ther Med 2018; 15:5275-5280. [PMID: 29904410 PMCID: PMC5996675 DOI: 10.3892/etm.2018.6114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 04/20/2018] [Indexed: 11/30/2022] Open
Abstract
Factors influencing N-terminal pro-brain natriuretic peptide (NT-proBNP) level in heart failure patients with different cardiac functions were identified to explore the correlations with prognosis. Eighty heart failure patients with different cardiac functions treated in Yixing People's Hospital from January 2016 to June 2017 were selected, and divided into two groups (group with cardiac function in class II and below and group with cardiac function in class III and above), according to the cardiac function classification established by New York Heart Association (NYHA). Blood biochemical test and outcome analysis were conducted to measure serum NT-proBNP and matrix metalloproteinase-9 (MMP-9) levels in patients with different cardiac functions, and correlations between levels of NT-proBNP and MMP-9 and left ventricular ejection fraction (LVEF) level were analyzed in patients with different cardiac functions at the same time. In addition, risk factors for heart failure in patients with different cardiac functions were analyzed. Compared with the group with cardiac function in class III and above, the group with cardiac function in class II and below had significantly lower serum NT-proBNP and MMP-9 levels (p<0.05). For echocardiogram indexes, left ventricular end-diastolic diameter (LVEDD) and left ventricular end-systolic diameter (LVESD) in the group with cardiac function in class II and below were obviously lower than those in the group with cardiac function in class III and above (p<0.05), while LVEF was higher in group with cardiac function in class II and below than that in group with cardiac function in class III and above (p<0.05). NT-proBNP and MMP-9 levels were negatively correlated with LVEF level [r=−0.8517 and −0.8517, respectively, p<0.001 (<0.05)]. Cardiac function in class III and above, increased NT-proBNP, increased MMP-9 and decreased LVEF were relevant risk factors and independent risk factors for heart failure in patients with different cardiac functions. NT-proBNP and MMP-9 levels are negatively correlated with LVEF in patients regardless of the cardiac function class. Therefore, attention should be paid to patients who have cardiac function in class III and above, increased NT-proBNP and MMP-9 levels and decreased LVEF in clinical practices, so as to actively prevent and treat heart failure.
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Affiliation(s)
- Liang Xu
- Department of Cardiovascular Disease, Yixing People's Hospital, Yixing, Jiangsu 214200, P.R. China
| | - Yanchun Chen
- Department of Cardiovascular Disease, Yixing People's Hospital, Yixing, Jiangsu 214200, P.R. China
| | - Yanni Ji
- Department of Cardiovascular Disease, Yixing People's Hospital, Yixing, Jiangsu 214200, P.R. China
| | - Song Yang
- Department of Cardiovascular Disease, Yixing People's Hospital, Yixing, Jiangsu 214200, P.R. China
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