Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy
Abstract 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 (P...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-08-01
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| Series: | ESC Heart Failure |
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| Online Access: | https://doi.org/10.1002/ehf2.12462 |
| _version_ | 1819204918185033728 |
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| author | Darlington O. Okonko Fadi Jouhra Huda Abu‐Own Gerasimos Filippatos Josep Comin Colet Chainey Suki Claudio Mori Piotr Ponikowski Stefan D. Anker for the FAIR‐HF Investigators |
| author_facet | Darlington O. Okonko Fadi Jouhra Huda Abu‐Own Gerasimos Filippatos Josep Comin Colet Chainey Suki Claudio Mori Piotr Ponikowski Stefan D. Anker for the FAIR‐HF Investigators |
| author_sort | Darlington O. Okonko |
| collection | DOAJ |
| description | Abstract 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. |
| first_indexed | 2024-12-23T04:43:26Z |
| format | Article |
| id | doaj.art-0844b3e1416d45d695ff24717fdf3b1c |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-23T04:43:26Z |
| publishDate | 2019-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-0844b3e1416d45d695ff24717fdf3b1c2022-12-21T17:59:42ZengWileyESC Heart Failure2055-58222019-08-016462162810.1002/ehf2.12462Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudyDarlington O. Okonko0Fadi Jouhra1Huda Abu‐Own2Gerasimos Filippatos3Josep Comin Colet4Chainey Suki5Claudio Mori6Piotr Ponikowski7Stefan D. Anker8for the FAIR‐HF InvestigatorsSchool of Cardiovascular Medicine and Sciences James Black Centre, King's College London British Heart Foundation Centre of Excellence London UKKing's College Hospital London UKKing's College Hospital London UKNational and Kapodistrian University of Athens Attikon University Hospital Athens GreeceHospital del Mar (Parc de Salut Mar) Barcelona SpainVifor Pharma Ltd Glattbrugg SwitzerlandVifor Pharma Ltd Glattbrugg SwitzerlandMedical University Wroclaw PolandDivision of Cardiology and Metabolism–Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK); and Berlin‐Brandenburg Center for Regenerative Therapies (BCRT); Deutsches Zentrum für Herz‐Kreislauf‐Forschung (DZHK) Berlin Charité Universitätsmedizin Berlin Berlin GermanyAbstract 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.https://doi.org/10.1002/ehf2.12462IronCongestionPlasma volumeOedema |
| spellingShingle | Darlington O. Okonko Fadi Jouhra Huda Abu‐Own Gerasimos Filippatos Josep Comin Colet Chainey Suki Claudio Mori Piotr Ponikowski Stefan D. Anker for the FAIR‐HF Investigators Effect of ferric carboxymaltose on calculated plasma volume status and clinical congestion: a FAIR‐HF substudy ESC Heart Failure Iron Congestion Plasma volume Oedema |
| 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 | Iron Congestion Plasma volume Oedema |
| url | https://doi.org/10.1002/ehf2.12462 |
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