Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion : a FAIR-HF substudy
Okonko, Darlington O. (King's College Hospital NHS Foundation Trust)
Jouhra, Fadi (King's College London)
Abu-Own, Huda (King's College London)
Filippatos, Gerasimos (National and Kapodistrian University of Athens)
Comín-Colet, Josep (Hospital del Mar (Barcelona, Catalunya))
Suki, Chainey (Vifor Pharma, Glattbrugg, Switzerland)
Mori, Claudio (Vifor Pharma, Glattbrugg, Switzerland)
Ponikowski, Piotr (Wroclaw Medical University)
Anker, Stefan D. (Charité - Universitätsmedizin Berlin)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	Aims: Iron deficiency worsens symptoms, quality of life, and exercise capacity in chronic heart failure (CHF) and might do so by promoting fluid retention. We assessed whether iron repletion improved congestion in CHF and appraised the prognostic utility of calculated plasma volume status (PVS), a novel index of congestion, in the FAIR-HF data set. Methods and results: In FAIR-HF, 459 iron deficient CHF patients were randomized to intravenous ferric carboxymaltose (FCM) or saline and assessed at 4, 12, and 24 weeks. Using weight and haematocrit, we calculated PVS in 436 patients. At baseline, PVS and weight were −5. 5 ± 7. 7% and 76. 9 ± 14. 3 kg, with peripheral oedema evident in 35% of subjects. Higher PVS values correlated to other congestion surrogates such as lower serum albumin. At 4 weeks, FCM was associated with greater reductions in weight (0. 02) and PVS (P < 0. 0001), and a trend for improved peripheral oedema at 24 weeks (0. 07). Irrespective of treatment allocation, patients with a decrease in PVS from baseline to week 24 had higher increments in 6 min walking distance (61. 4 m vs. 43. 5 m, 0. 02) and were more likely to improve their NYHA class (33. 3% vs. 15. 5%, 0. 001). A PVS > −4% at baseline predicted worse outcomes even after adjustment for treatment assignment (hazard ratio 1. 88, 95% confidence interval 1. 01-3. 51, 0. 046). Conclusions: Intravenous iron therapy with FCM is associated with early reductions in PVS and weight, implying that decongestion might be one mechanism via which iron repletion aids CHF patients. Calculated PVS is of prognostic utility in this cohort.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Iron ; Congestion ; Plasma volume ; Oedema
Publicat a:	ESC Heart Failure, Vol. 6 Núm. 4 (january 2019) , p. 621-628, ISSN 2055-5822

DOI: 10.1002/ehf2.12462
PMID: 31148411

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