Correction of anemic syndrome in patients with chronic heart failure with intravenous iron-containing complex

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Abstract


Aim. To evaluate efficacy of intravenous iron (III) hydroxide sucrose complex for anemic sydrome correction in patients with chronic heart failure and anemia.

Methods. 126 patients with chronic heart failure of ischemic etiology of I-IV NYHA functional class were examined, 92 of them were diagnosed with anemia. The average age of patients was 60.6±1.4 years. All patients were randomized into 2 groups. Group 1 included 49 patients with chronic heart failure and anemia who received only basic therapy, including angiotensin converting enzyme inhibitors, β-blockers, diuretics, digoxin, and nitrates. Group 2 included 43 patients with chronic heart failure, anemia and iron deficiency who received combination therapy with intravenous iron (III) hydroxide sucrose complex (Venofer) and basic therapy. In all patients on the treatment levels of hemoglobin, ferritin, transferrin saturation, erythropoietin, N terminal pro brain natriuretic peptide, interleukin 1, interleukin 6, tumor necrosis factor α in plasma, parameters of systolic and diastolic function of the left ventricle myocardium by echocardiography and doppler echocardiography were evaluated dynamically.

Results. In patients with chronic heart failure of I-IV NYHA class and anemia (group 1) on the background of basic therapy, no positive dynamics was registered for levels of hemoglobin, hematocrit, ferritin, transferrin saturation, erythropoietin, N terminal pro brain natriuretic peptide, interleukin 1, interleukin 6, and tumor necrosis factor α. In group 2 during therapy there was a significant increase of the level of hemoglobin, plasma ferritin and transferrin saturation.

Conclusion. Patients with chronic heart failure of I-IV NYHA functional class, anemia, iron deficiency and normoerythropoietinaemia or hypererythropoietinaemia, administration of intravenous iron (III) hydroxide sucrose complex (Venofer) with basic therapy is recommended.


K Kh Zakhidova

Author for correspondence.
nauchnayastatya@yandex.ru
Azerbaijan State Advanced Training Institute for Doctors named after A. Aliyev Baku, Azerbaijan

  • SOLVD Investigators, Yusuf S., Pitt B. et al. Effect of Enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New Eng. J. Med. 1991; 325 (5): 293-302. doi: 10.1056/NEJM199108013250501.
  • Mac-Murrey J.J., Pfeffer M.A. Heart failure. Lancet. 2005; 365 (9474): 1877-1889. doi: 10.1016/S0140-6736(05)66621-4.
  • Lindenfeld J. Prevalence of anemia and effects on mortality in patients with heart failure. Am. Heart J. 2005; 149 (3): 391-401. doi: 10.1016/j.ahj.2004.08.039.
  • Ezekowitz J.A., McAlister F.A., Armstrong P.W. Anemia is common in heart failure and is associated with poor outcomes. Circulation. 2003; 21: 223-225. doi: 10.1161/01.CIR.0000052622.51963.FC.
  • Stamos T.D., Silver M.A. Management of anemia in heart failure. Curr. Opin. Cardiol. 2010; 25: 148-154. doi: 10.1097/HCO.0b013e3283357fe0.
  • Anand I.S., Kuskowski M.A., Rector T.S. et al. Anemia and change in hemoglobin over time related to mortality and morbidity in patients with chronic heart failure: results from Val-HeFT. Circulation. 2005; 112 (8): 1121-1127. doi: 10.1161/CIRCULATIONAHA.104.512988.
  • House A.A., Haapio M., Lassus J. et al. Therapeutic strategies for heart failure in cardiorenal syndromes. Am. J. Kidney Dis. 2010; 56 (4): 759-773. doi: 10.1053/j.ajkd.2010.04.012.
  • Opasich C., Cazzola M., Scelsi L. et al. Blunted erythropoietin production and detective iron supply for erythropoiesis as major causes of anaemia in patients of chronic heart failure. Eur. Heart J. 2005; 26: 2232-2237. doi: 10.1093/eurheartj/ehi388.
  • Toblli J.E., Lombrana A., Duarte P. et al. Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J. Am. Coll. Cardiol. 2007; 50: 1657-1665. doi: 10.1016/j.jacc.2007.07.029.
  • Okonko D.O., Grzeslo A., Witkowski T. et al. Effect ofintravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J. Am. Coll. Cardiol. 2008; 51 (2): 103-112. doi: 10.1016/j.jacc.2007.09.036.
  • Usmanov R.I., Zueva E.B., Silverberg D.S. et al. Intravenous iron without erythropoietin for the treatment of iron deficiency anemia in patients with moderate to severe congestive heart failure and chronic kidney insufficiency. J. Nephrol. 2008; 21 (2): 236-242. PMID: 18446719.
  • Beck-da-Silva L., Piardi D., Soder S. et al. IRON-HF study: a randomized trial to assess the effects of iron in heart failure patients with anemia. Int. J. Cardiol. 2013; 168 (4): 3439-3442. doi: 10.1016/j.ijcard.2013.04.181.
  • Anker S.D., Comin Colet J., Filippatos G. et al. FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N. Engl. J. Med. 2009; 361 (25): 2436-2448. doi: 10.1056/NEJMoa0908355.

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