Ferric Carboxymaltose in Heart Failure with Iron Deficiency

New England Journal of Medicine, Journal Year: 2023, Volume and Issue: 389(11), P. 975 - 986

Published: Aug. 26, 2023

Ferric carboxymaltose therapy reduces symptoms and improves quality of life in patients who have heart failure with a reduced ejection fraction iron deficiency. Additional evidence about the effects ferric on clinical events is needed. Download PDF Research Summary. In this double-blind, randomized trial, we assigned ambulatory failure, left ventricular 40% or less, deficiency, 1:1 ratio, to receive intravenous placebo, addition standard for failure. placebo was given every 6 months as needed basis indexes hemoglobin levels. The primary outcome hierarchical composite death within 12 after randomization, hospitalizations change from baseline 6-minute walk distance. significance level set at 0.01. We enrolled 3065 patients, whom 1532 were randomly group 1533 group. Death by month occurred 131 (8.6%) 158 (10.3%) group; total 297 332 respectively, 12; mean (±SD) distance 8±60 4±59 m, respectively (Wilcoxon–Mann–Whitney P=0.02; unmatched win 1.10; 99% confidence interval, 0.99 1.23). Repeated dosing appeared be safe an acceptable adverse-event profile majority patients. number serious adverse occurring during treatment period similar two groups (413 [27.0%] 401 [26.2%] group). Among had there no apparent difference between respect death, (Funded American Regent, Daiichi Sankyo Group company; HEART-FID ClinicalTrials.gov number, NCT03037931.) QUICK TAKE VIDEO SUMMARYFerric Carboxymaltose HF Iron Deficiency 01:52

Language: Английский

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Iron homeostasis and ferroptosis in human diseases: mechanisms and therapeutic prospects

Signal Transduction and Targeted Therapy, Journal Year: 2024, Volume and Issue: 9(1)

Published: Oct. 14, 2024

Iron, an essential mineral in the body, is involved numerous physiological processes, making maintenance of iron homeostasis crucial for overall health. Both overload and deficiency can cause various disorders human diseases. Ferroptosis, a form cell death dependent on iron, characterized by extensive peroxidation lipids. Unlike other kinds classical unprogrammed death, ferroptosis primarily linked to disruptions metabolism, lipid peroxidation, antioxidant system imbalance. Ferroptosis regulated through transcription, translation, post-translational modifications, which affect cellular sensitivity ferroptosis. Over past decade or so, diseases have been as part their etiology, including cancers, metabolic disorders, autoimmune diseases, central nervous cardiovascular musculoskeletal Ferroptosis-related proteins become attractive targets many major that are currently incurable, some regulators shown therapeutic effects clinical trials although further validation potential needed. Therefore, in-depth analysis its molecular mechanisms may offer additional strategies prevention treatment. In this review, we discuss significance contribution etiology development along with evidence supporting targeting approach. Importantly, evaluate recent promising interventions, providing guidance future targeted treatment therapies against

Language: Английский

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Rationale and design of the FAIR‐HF2‐DZHK05 trial: Ferric carboxymaltose assessment of morbidity and mortality in patients with iron deficiency and chronic heart failure

European Journal of Heart Failure, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 28, 2025

Abstract Aims While it is widely accepted that intravenous (IV) iron improves functional capacity, symptoms, and cardiovascular outcomes in patients with heart failure (HF) reduced ejection fraction (HFrEF) diagnosed deficiency (ID), three recently published outcome trials (AFFIRM‐AHF, IRONMAN HEART‐FID) of IV supplementation HF failed to demonstrate a significant benefit on their respective primary endpoints. Dosing after the initial correction baseline ID – by design or as result trial circumstances was relatively low (i.e. <500 mg/year). The objective FAIR‐HF2 evaluate treatment effect ferric carboxymaltose (FCM) compared placebo ambulatory HFrEF using higher dose during follow‐up >1000 second study create prospective evidence for fulfilling new definition HF, i.e. those transferrin saturation <20%. Methods an investigator‐initiated, multicentre, randomized, double‐blind, placebo‐controlled has recruited 1105 chronic left ventricular ≤45% concomitant ID, defined serum ferritin <100 ng/ml 100–299 Patients were consented randomized receive either FCM (treatment) saline (placebo). During estimated median over 2 years, underwent repletion maintenance phase, up 2000 mg, followed 500 mg every 4 months unless stop criteria haemoglobin >16 mg/dl >800 are met repeat visits. will hypotheses: (i) time first event death hospitalization (ii) rate total (first recurrent) hospitalizations (both analysed full population), (iii) <20% at baseline. familywise type I error across endpoint hypotheses be controlled Hochberg procedure (alpha 0.05). Conclusion efficacy improving utilizing more aggressive approach towards ensuring prevention transitional targets have been met.

Language: Английский

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Iron deficiency and all-cause mortality after myocardial infarction

European Journal of Internal Medicine, Journal Year: 2024, Volume and Issue: 126, P. 102 - 108

Published: May 1, 2024

BackgroundData on the clinical significance of iron deficiency (ID) in patients with myocardial infarction (MI) are conflicting. This may be related to use various ID criteria.We aimed compare association different criteria all-cause mortality after MI.MethodsConsecutive hospitalized for their first MI at a large tertiary heart center were included. We evaluated metabolism parameters measured day hospital admission mortality.ResultsFrom 1,156 included (aged 64±12 years, 25 % women), 194 (16.8 %) died during median follow-up 3.4 years. After multivariate adjustment, level ≤13 µmol/L (HR 1.67, 95 CI 1.19–2.34) and combination ≤12.8 soluble transferrin receptor (sTfR) ≥3 mg/L 2.56, 1.64–3.99) termed as PragueID associated increased risk had additional predictive value GRACE score. Compared model including level, addition sTfR improved stratification (net reclassification improvement 0.61, 0.52–0.69) by reclassifying into higher-risk group. No between ferritin was found. 51 low levels, 58 fulfilled criteria.ConclusionIron is common among MI. The based levels provide best prediction should future interventional studies identification potentially benefiting from intravenous therapy.

Language: Английский

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Critical re‐evaluation of the identification of iron deficiency states and effective iron repletion strategies in patients with chronic heart failure

European Journal of Heart Failure, Journal Year: 2024, Volume and Issue: 26(6), P. 1298 - 1312

Published: May 10, 2024

Abstract According to current guidelines, iron deficiency is defined by a serum ferritin level <100 ng/ml or transferrin saturation (TSAT) <20% if the 100–299 μg/L. These criteria were developed encourage use of intravenous as an adjunct erythropoiesis‐stimulating agents in treatment renal anaemia. However, patients with heart failure, these are not supported any pathophysiological clinical evidence that they identify absolute functional state. A low baseline TSAT—but level—appears be reliable indicator effect reduce major failure events. In randomized controlled trials, decreased risk cardiovascular death total hospitalization TSAT (risk ratio 0.67 [0.49–0.92]) but ≥20% 0.99 [0.74–1.30]), magnitude reduction being proportional severity hypoferraemia. Patients who enrolled trials solely because had μg/L showed no significant benefit on outcomes, and it noteworthy levels 20–300 lie entirely within range normal values for healthy adults. Current guidelines reflect eligibility which inadvertently adopted unvalidated define deficiency. Reliance would lead many deficient (serum TSAT) ignores possibility >300 Importantly, analyses based trial eligibility‐driven substantially underestimate heart‐failure‐event truly deficient. Based all available data, we recommend new mechanism‐based trial‐tested approach reflects totality more faithfully than historical process investigators guidelines. Until additional forthcoming, state should (as long <400 μg/L), furthermore, alone diagnostic criterion discarded.

Language: Английский

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Intravenous Iron Sucrose for Acute Decompensated Heart Failure Patients with Reduced Ejection Fraction and Iron Deficiency

Reviews in Cardiovascular Medicine, Journal Year: 2025, Volume and Issue: 26(4)

Published: April 17, 2025

Background: The concurrent presence of iron deficiency (ID) and heart failure (HF) can worsen prognosis reduce the quality life for affected individuals. This study aimed to explore effects incorporating sucrose into standard HF treatments patients with acute decompensated ID. Methods: We prospectively enrolled 65 hospitalized patients, all a left ventricular ejection fraction ≤40% ID, defined as ferritin levels below 100 ng/mL or between 299 transferrin saturation 20%. Patients were randomized two groups: group, who received intravenous in addition treatment; control group treatment alone serum ferritin, iron, saturation, Kansas City Cardiomyopathy Questionnaire (KCCQ) scores measured at baseline 4-week follow-up. Results: Baseline characteristics, profiles, KCCQ comparable groups. At 4 weeks, possessed significantly higher than those (ferritin 485.3 ± 269.7 vs. 225.5 162.5 ng/mL, p < 0.001; Δferritin 382.2 243.5 97.4 143.0 0.001, respectively). Only 9.1% remained within ID criteria, compared 36.7% (p = 0.012). ΔKCCQ score was 10.6 points (27.8 19.5 17.1 17.8 points, 0.031) group. Conclusions: Post-discharge may improve Clinical trial registration: NCT06703411, https://clinicaltrials.gov/expert-search?term=NCT06703411.

Language: Английский

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Associations of iron metabolism and inflammation with all-cause and cardiovascular mortality in a large NHANES community sample: Moderating and mediating effects

Nutrition Metabolism and Cardiovascular Diseases, Journal Year: 2024, Volume and Issue: 34(8), P. 1854 - 1863

Published: March 27, 2024

Language: Английский

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Temporal Analysis in Outcomes of Long-Term Mechanical Circulatory Support: Retrospective Study

The Thoracic and Cardiovascular Surgeon, Journal Year: 2024, Volume and Issue: 72(07), P. 521 - 529

Published: April 19, 2024

Mechanical assist device indications have changed in recent years. Reduced incidence of complications, better survival, and the third generation mechanical support devices contributed to this change. In single-center study, we focused on two time periods that are characterized by use different types devices, patient characteristics, change indications.

Language: Английский

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REVOLUTION in Heart Failure Care and SELECT Highlights From the European Society of Cardiology-Heart Failure Association Heart Failure & World Congress on Acute Heart Failure 2024

Journal of Cardiac Failure, Journal Year: 2024, Volume and Issue: 30(9), P. 1157 - 1160

Published: June 3, 2024

Language: Английский

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Management of Iron Deficiency in Heart Failure

JACC Heart Failure, Journal Year: 2024, Volume and Issue: 12(12), P. 1961 - 1978

Published: July 10, 2024

Language: Английский

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