Early improvement of global longitudinal strain after iron deficiency correction in heart failure with reduced ejection fraction.

BACKGROUND: Iron deficiency correction with ferric carboxymaltose improves symptoms and reduces rehospitalization in patients with reduced left ventricular ejection fraction. The mechanisms underlying these improvements are poorly understood. This study aimed to determine changes in left ventricular contractility after iron treatment as reflected in global longitudinal strain. METHODS: Prospective single-center study including 43 adults with reduced ejection fraction, non-anemic iron deficiency, and functional class II-III heart failure despite optimal medical treatment. Global longitudinal strain through speckle-tracking echocardiography was measured at baseline and 4 weeks after ferric carboxymaltose. RESULTS: A significant improvement in global longitudinal strain was detected (from -12.3% ± 4.0% at baseline to -15.6% ± 4.1%, p < .001); ferritin and transferrin saturation index had increased, but ejection fraction presented no significant changes (baseline 35.7% ± 4.6%, follow-up 37.2% ± 6.6%, p = .073). CONCLUSIONS: In patients with heart failure and reduced ejection fraction, the correction of iron deficiency with ferric carboxymaltose is associated with an early improvement in global longitudinal strain, possibly suggesting a direct effect of iron correction on myocardial contractility.

Anemia and iron deficiency in heart failure: a review of echocardiographic features.

Anemia and iron deficiency are often associated with heart failure, influencing the symptoms and prognosis. Correction of anemia and iron deficiency improves functional capacity and decreases hospitalizations. Many studies have analyzed echocardiographic parameters in iron deficiency and anemia and their evolution after iron treatment; however, the heterogeneity of the results makes it difficult to draw conclusions. The aim of this paper is to review the echocardiographic parameters during anemia and iron deficiency, and their evolution after treatment. Available data suggest that they lead to ventricular and atrial remodeling, a decrease in ventricular contractility, and an alteration of ventricular relaxation, although in heart failure with preserved ejection fraction these changes are not significant. Anemia and iron deficiency also increase systolic pulmonary artery pressure. There is consistent evidence that correction of these comorbidities leads to a reduction in preload and left ventricular cavity dimensions, an improvement in diastolic and load-independent ventricular systolic function parameters, and a decrease in systolic pulmonary artery pressure. However, the evidence is less consistent about the changes produced in ventricular hypertrophy, load-dependent systolic function parameters, and E-wave. Generally, anemia and iron deficiency affect the echocardiographic findings, and correcting these conditions often results in improvement in the affected echocardiographic parameters.

High incidence of TIMI flow 0 to I in patients with ST-elevation myocardial infarction without electrocardiographic lytic criteria.

BACKGROUND: Most patients with ST-elevation myocardial infarction fulfilling ST-segment elevation (STE) lytic criteria present an occluded culprit artery but the occlusion rate in those with minimal STE (minSTE) not fulfilling lytic criteria is unknown. METHODS: In 63 patients with minSTE (mean STE:1.2 +/- 0.6 mm) and 149 with lytic STE criteria (lyticSTE, 4.8 +/- 3.1 mm), an emergency coronary angiography was performed, serial creatine kinase-MB was determined, and ejection fraction was measured by 2-dimensional echocardiography. RESULTS: The 2 groups showed similar time from pain onset to electrocardiogram (minSTE 196 +/- 199 vs lyticSTE, 176 +/- 172 min, P = .444), and although time to catheterization was longer in patients with minSTE (426 +/- 314 vs 253 +/- 239 min, P < .001), the rate of TIMI flow 0 to I (88% vs 81%, P = .21) was similar and percutaneous coronary intervention was performed in >80% of patients from the 2 groups. Moreover, patients with minSTE had higher rate of collateral circulation (27% vs 13%, P = .013), lower rate of Q waves (44% vs 60%, P = .041), lower creatine kinase-MB (202 +/- 150 vs 335 +/- 280, microg/L, P < .001), higher ejection fraction (54% +/- 9% vs 49% +/- 12%, P = .004), and lower mortality (0% vs 7.4%, P = .036). CONCLUSIONS: ST-elevation myocardial infarction patients with minSTE present a high prevalence of TIMI flow 0 to I similar to those meeting lyticSTE suggesting an identical underlying mechanism and the potential to benefit from primary angioplasty.

A pilot evaluation of the long-term effect of combined therapy with intravenous iron sucrose and erythropoietin in elderly patients with advanced chronic heart failure and cardio-renal anemia syndrome: influence on neurohormonal activation and clinical outcomes.

BACKGROUND: The prognosis in elderly patients with advanced chronic heart failure (CHF) and cardio-renal anemia syndrome (CRAS) is ominous, and treatment alternatives in this subset of patients are scarce. METHODS AND RESULTS: To assess the long-term influence of combined therapy with intravenous (IV) iron and erythropoietin (rHuEPO) on hemoglobin (Hb), natriuretic peptides (NT-proBNP), and clinical outcomes in elderly patients with advanced CHF and mild-to-moderate renal dysfunction and anemia (CRAS) who are not candidates for other treatment alternatives, 487 consecutive patients were evaluated. Of them, 65 fulfilling criteria for entering the study were divided into 2 groups and treated in an open-label, nonrandomized fashion: intervention group (27, combined anemia therapy) and control group (38, no treatment for anemia). At baseline, mean age was 74 +/- 8 years, left ventricular ejection fraction was 34.5 +/- 14.1, Hb was 10.9 +/- 0.9 g/dL, creatinine was 1.5 +/- 0.5 mg/dL, NT-proBNP was 4256 +/- 4952 pg/mL, and 100% were in persistent New York Heart Association (NYHA) Class III or IV. At follow-up (15.3 +/- 8.6 months), patients in the intervention group had higher levels of hemoglobin (13.5 +/- 1.5 vs. 11.3 +/- 1.1; P < .0001), lower levels of natural log of NT-proBNP (7.3 +/- 0.8 vs. 8.0 +/- 1.3, P = .016), better NYHA functional class (2.0 +/- 0.6 vs. 3.3 +/- 0.5; P < .001), and lower readmission rate (25.9% vs. 76.3%; P < .001). In the multivariate Cox proportional hazards model, combined therapy was associated with a reduction of the combined end point all-cause mortality or cardiovascular hospitalization (HR 95%CI 0.2 [0.1-0.6]; P < .001). CONCLUSION: Long-term combined therapy with IV iron and rHuEPO may increase Hb, reduce NT-proBNP, and improve functional capacity and cardiovascular hospitalization in elderly patients with advanced CHF and CRAS with mild to moderate renal dysfunction.

Manejo ambulatorio de la insuficiencia cardíaca crónica en la Argentina: estudio OFFICE IC / Outpatient handling of chronic heart failure in Argentina: the OFFICE IC study

Objetivo: Conocer las características basales y las modalidades diagnósticas y terapéuticas habituales en el tratamiento de pacientes con insuficiencia cardíaca crónica en la Argentina. Material y métodos: Fueron encuestados 241 médicos de todo el país (91,7 por ciento cardiólogos), cada uno de los cuales comunicó datos referidos al perfil clínico, estudios realizados y tratamiento de pacientes con insuficiencia cardíaca crónica en seguimiento ambulatorio. Resultados: Se obtuvieron datos de 2201 pacientes (64,6 por ciento hombres, edad media 67,6 ± 12 años) entre junio de 2003 y marzo de 2004. El 58 por ciento habían sido internados por insuficiencia cardíaca en los 2 años previos. Se encontraban en CF I-II el 73,5 por ciento de los pacientes. Las etiologías predominantes fueron la isquémica (40,5 por ciento) y la hipertensiva (23,7 por ciento). En el 88,5 por ciento de los pacientes se conocía la función ventricular (disfunción sistólica moderada a severa en más del 70 por ciento). Estaban medicados con digital el 33 por ciento, con inhibidores de la enzima convertidora y/o antagonistas de la angiotensina II el 92,2 por ciento, con betabloqueantes el 70 por ciento y con espironolactona el 61,7 por ciento. La etiología, la función ventricular, la cobertura médica y el tratamiento concomitante fueron predictores del uso de antagonistas neurohormonales. Conclusiones: Los pacientes incluidos son similares a los de otros registros poblacionales, con predominio de hombres y etiología isquémica e hipertensiva. La mayor parte de los pacientes presentó disfunción sistólica. El tratamiento de acuerdo con los estándares de las guías actuales se cumplió en una elevada proporción de pacientes.

Registro Nacional de internación por insuficiencia cardíaca 2002-2003 / National survey of hospitalization of patients with heart failure, 2002-2003

Objetivos: Describir el perfil de una cohorte de pacientes internados por insuficiencia cardíaca (IC), evaluar patrones de presentación, modalidades diagnósticas y terapéuticas, utilización de recursos y evolución hospitalaria. Comparar con el registro del Área de Investigación de la SAC 1999. Materiales y métodos: Se incluyeron prospectivamente 615 pacientes mayores de 18 años internados por IC descompensada en 36 centros participantes entre mayo de 2002 y marzo de 2003. Se recabaron datos de filiación, socioeconómicos, antecedentes patológicos y relativos a la evolución hospitalaria. Resultados: La media de edad fue de 70 años, predominio masculino. Se observó un alto porcentaje de comorbilidades (40,3 por ciento), antecedentes de IC (72,8 por ciento) y factores desencadenantes (73,8 por ciento). Predominaron las formas leves de presentación (67,2 por ciento), con alto porcentaje de ingreso en cuidados intensivos (57,7 por ciento). La mortalidad hospitalaria fue del 9,94 por ciento. Formas de presentación severas y el grado de cobertura médica predijeron en forma independiente internación en cuidados críticos e internación prolongada, mientras que variables clínicas como edad avanzada, diabetes, urea elevada, hipotensión sistólica, tercer ruido e hiponatremia se asociaron independientemente con mayor mortalidad. Una mayor utilización de betabloqueantes y antagonistas de angiotensina II se asoció independientemente a pertenecer a la cohorte de 2002. Conclusiones: La población internada por IC es añosa, con elevada prevalencia de IC previa y comorbilidades. Existen factores predisponentes potencialmente prevenibles y muchos pacientes no graves internados en cuidados intensivos. La ausencia de cobertura médica define independientemente la no internación en cuidados críticos así como una internación prolongada. Variables clínicas simples fueron predictoras de mayor mortalidad.