Heart failure with preserved ejection fraction and iron deficiency: effects of intravenous iron therapy with one-year prospective follow-up

Introduction. Heart failure with preserved ejection fraction (HFpEF) is characterized by a high comorbidity. Iron deficiency (ID) is one of the most common comorbidities in HFpEF, the frequency of which can reach 80% [3]. There is insufficient data on the efficacy, appropriateness, and long-term outcomes of intravenous iron therapy in this patient cohort, underscoring the relevance of research in this area.

Aim: To evaluate the dynamics of the clinical presentation, quality of life (QoL) and functional status (FS), as well as laboratory parameters of iron metabolism in patients with HFpEF during a prospective one-year follow-up after correction of ID by using intravenous ferric carboxymaltose therapy.

Material and Methods. The study included 58 patients with HFpEF and ID. The median age of the patients was 67 [65; 73] years; 65.5% of them were women (n = 38). ID correction using intravenous iron therapy was performed in 23 patients (group 1). Patients who were not given the drug to correct ID were included in the control group 2 (n = 35). Baseline and 6-, 12-month, an intragroup and intergroup analysis of the laboratory parameters of ID, the clinical picture of HFpEF, indicators of FS was performed the 6-minute walk test (6MWT) and QoL using the Minnesota Living with Heart Failure Questionnaire (MHLFQ) and the nonspecific SF-36 quality of life questionnaire. Additionally, a subgroup of patients with latent ID was analyzed in relation to the studied parameters (n = 49).

Results. After 6 months in group 1, there was a decrease in the frequency of symptoms such as increased fatigue (p = 0.002), more than half of the patients noted a subjective improvement in exercise tolerance (p < 0.001), which was confirmed by an increase in the distance traveled in 6MWT (p = 0.002), an improvement in MHFLQ results (p < 0.001), indicators of physical functioning (p < 0.001) and general perception of health (p = 0.003) according to the SF-36 questionnaire. In the subgroup with latent ID, the revealed differences persisted with respect to distance in 6MWT (p = 0.042) and tended towards quality of life according to MHFLQ (p = 0.068). The revealed differences persisted after 12 months. Correlation analysis revealed that a more pronounced positive dynamics of the studied parameters was observed with a lower initial ferritin level: for the 6MWT dynamics, the correlation coefficient was r = –0.775 (p = 0.001), for the MHFLQ indicators – r = 0.625 (p = 0.006).

Conclusion. In patients with HFpEF, intravenous correction of concomitant ID, including latent ID, has a positive effect on FS and QoL, which persists for 1 year after ferrotherapy. At the same time, the effect is more pronounced the lower the initial ferritin values, which confirms the need for active detection of ID in a cohort of patients with HFpEF by determining not only a general clinical blood test, but also indicators of iron metabolism. At the same time, the issue of finding optimal markers and criteria for ID in patients with HFpEF remains open and requires further research.

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