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Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy

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 n...

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Autores principales: Okonko, Darlington O., Jouhra, Fadi, Abu‐Own, Huda, Filippatos, Gerasimos, Colet, Josep Comin, Suki, Chainey, Mori, Claudio, Ponikowski, Piotr, Anker, Stefan D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676445/
https://www.ncbi.nlm.nih.gov/pubmed/31148411
http://dx.doi.org/10.1002/ehf2.12462
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author Okonko, Darlington O.
Jouhra, Fadi
Abu‐Own, Huda
Filippatos, Gerasimos
Colet, Josep Comin
Suki, Chainey
Mori, Claudio
Ponikowski, Piotr
Anker, Stefan D.
author_facet Okonko, Darlington O.
Jouhra, Fadi
Abu‐Own, Huda
Filippatos, Gerasimos
Colet, Josep Comin
Suki, Chainey
Mori, Claudio
Ponikowski, Piotr
Anker, Stefan D.
author_sort Okonko, Darlington O.
collection PubMed
description 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.
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spelling pubmed-66764452019-08-06 Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy Okonko, Darlington O. Jouhra, Fadi Abu‐Own, Huda Filippatos, Gerasimos Colet, Josep Comin Suki, Chainey Mori, Claudio Ponikowski, Piotr Anker, Stefan D. ESC Heart Fail Original Research Articles 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. John Wiley and Sons Inc. 2019-05-30 /pmc/articles/PMC6676445/ /pubmed/31148411 http://dx.doi.org/10.1002/ehf2.12462 Text en © 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.
spellingShingle Original Research Articles
Okonko, Darlington O.
Jouhra, Fadi
Abu‐Own, Huda
Filippatos, Gerasimos
Colet, Josep Comin
Suki, Chainey
Mori, Claudio
Ponikowski, Piotr
Anker, Stefan D.
Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
title Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
title_full Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
title_fullStr Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
title_full_unstemmed Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
title_short Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
title_sort effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a fair‐hf substudy
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676445/
https://www.ncbi.nlm.nih.gov/pubmed/31148411
http://dx.doi.org/10.1002/ehf2.12462
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