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Iron deficiency in patients with heart failure with mid-range and preserved ejection fraction
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Introdução: O ferro é essencial para a produção de bioenergia, eficácia do sistema imunitário e desenvolvimento do sistema nervoso central. Em pacientes com Insuficiência Cardíaca Crónica (ICC), o défice de ferro (DF) compromete a capacidade funcional, piora a qualidade de vida e aumenta a mortalidade. Não há dados sobre a identificação do DF e correção com carboximaltose férrica intravenosa (CMFiv) em pacientes com fração de ejeção intermédia e preservada (ICFEi/p). Métodos: Entre 2015 e 2016, identificámos e caracterizámos os pacientes sintomáticos com ICFEi/p que realizaram CMFiv para correção do DF, com ou sem anemia, e comparámo-los com os pacientes com ICFEr tratados no mesmo período. Depois, entre 2015 e 2018, examinámos a evolução dos pacientes com ICFEi/p face à sua classe NYHA, porção N-terminal do péptido natriurético tipo B (NTproBNP), e função renal aos três e seis meses após o tratamento. Resultados: No estudo de comparação, 52 pacientes com ICC e DF foram avaliados: idade média 86 anos, 69% eram homens. 34,6% apresentavam ICFEr e 65,4% ICFEi/p. 90,4% tinha anemia. DF funcional estava presente em 13% e 23% de ICFEr e ICFEi/p, respetivamente. Os pacientes com ICFEi/p tinham menos doença arterial coronária (44% e 78%) e menos diabetes mellitus (26% e 44%). Não se observaram diferenças nas outras comorbidades. No estudo de seguimento dos pacientes submetidos a CMFiv, identificámos 56 pacientes. 83% tinha DF absoluto e 75% anemia. 50% na classe II da NYHA e 46% na classe III. NTproBNP foi 6492pg/mL e a eGFREPI foi de 47,8mL/min/m^2. Aos três e seis meses, 59% e 61% estavam na classe II da NYHA e 39% e 37% na classe III. O NTproBNP foi 5331pg/mL e 4000pg/mL, e a eGFREPI foi 45,8mL/min/m^2 e 45,8mL/min/m^2. Conclusão: O DF é per si subavaliado na prática clínica. Aos três e seis meses após o tratamento com CMFiv, não observámos alterações significativas na eGFREPI, e constatámos uma melhoria funcional, conforme avaliada pela classe NYHA, bem como uma redução dos níveis de NTproBNP.
Introduction: Iron is essential in bioenergy production, immune system efficacity and central nervous system development. In Chronic Heart Failure (CHF) patients, ID impairs functional capacity, worsens quality of life and increases mortality. There is no data on identification and correction of ID with intravenous ferric carboxymaltose (ivFCM) in CHF patients with midrange and preserved ejection fraction (HFmr/pEF). Methods: Between 2015 and 2016 we identified and characterized symptomatic HFmr/pEF patients submitted to ivFCM treatment for ID correction with or without anemia and, compared them to the CHF patients with reduced ejection fraction (HFrEF) treated on the same period. Then, between 2015 and 2018, we investigated the evolution of HFmr/pEF patients’ NYHA class, NTproBNP and kidney function, at three and six months after treatment. Results: In the comparison study, 52 CHF patients with ID were evaluated: mean age 86 years, 69% were men, 34.6% had HFrEF and 65.4% HFmr/pEF. 90,4% had anemia. 13% and 23% of HFrEF and HFmr/pEF had respectively functional ID. HFmr/pEF patients had less ischemic heart disease (44% and 78%) and less diabetes mellitus (26% and 44%). No difference was seen in other comorbidities. In the evaluation study of patients submitted to ivFCM, 56 patients were included. 83% had absolute ID, 75% patients were anemic. 50% in NYHA class II and 46% in class III. NTproBNP was 6492pg/mL and eGFREPI was 47,8mL/min/m^2. At three and six months, 59% and 61% were in NYHA class II and 39% and 37% in class III. NTproBNP was 5331pg/mL and 4000pg/mL, the eGFREPI was 45,8mL/min/m^2 and 45,8mL/min/m^2. Conclusion: ID is per se poorly evaluated in routine practice. At three and six months after treatment with ivFCM, although no significant changes were seen in eGFREPI, a functional improvement, as assessed by the NYHA class, and a reduction of NTproBNP levels were observed.
Introduction: Iron is essential in bioenergy production, immune system efficacity and central nervous system development. In Chronic Heart Failure (CHF) patients, ID impairs functional capacity, worsens quality of life and increases mortality. There is no data on identification and correction of ID with intravenous ferric carboxymaltose (ivFCM) in CHF patients with midrange and preserved ejection fraction (HFmr/pEF). Methods: Between 2015 and 2016 we identified and characterized symptomatic HFmr/pEF patients submitted to ivFCM treatment for ID correction with or without anemia and, compared them to the CHF patients with reduced ejection fraction (HFrEF) treated on the same period. Then, between 2015 and 2018, we investigated the evolution of HFmr/pEF patients’ NYHA class, NTproBNP and kidney function, at three and six months after treatment. Results: In the comparison study, 52 CHF patients with ID were evaluated: mean age 86 years, 69% were men, 34.6% had HFrEF and 65.4% HFmr/pEF. 90,4% had anemia. 13% and 23% of HFrEF and HFmr/pEF had respectively functional ID. HFmr/pEF patients had less ischemic heart disease (44% and 78%) and less diabetes mellitus (26% and 44%). No difference was seen in other comorbidities. In the evaluation study of patients submitted to ivFCM, 56 patients were included. 83% had absolute ID, 75% patients were anemic. 50% in NYHA class II and 46% in class III. NTproBNP was 6492pg/mL and eGFREPI was 47,8mL/min/m^2. At three and six months, 59% and 61% were in NYHA class II and 39% and 37% in class III. NTproBNP was 5331pg/mL and 4000pg/mL, the eGFREPI was 45,8mL/min/m^2 and 45,8mL/min/m^2. Conclusion: ID is per se poorly evaluated in routine practice. At three and six months after treatment with ivFCM, although no significant changes were seen in eGFREPI, a functional improvement, as assessed by the NYHA class, and a reduction of NTproBNP levels were observed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Insuficiência cardíaca crónica Deficiência de ferro Cardiologia