Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study
Abstract Background Anemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb...
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| Format: | Article |
| Language: | English |
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BMC
2023-07-01
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| Series: | Perioperative Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13741-023-00319-x |
| _version_ | 1797784495378661376 |
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| author | James O. M. Plumb James M. Otto Shriya B. Kumar Sitara Bali Mai Wakatsuki Walter F. J. Schmidt Hugh E. Montgomery Michael P. W. Grocott Denny Z. Levett |
| author_facet | James O. M. Plumb James M. Otto Shriya B. Kumar Sitara Bali Mai Wakatsuki Walter F. J. Schmidt Hugh E. Montgomery Michael P. W. Grocott Denny Z. Levett |
| author_sort | James O. M. Plumb |
| collection | DOAJ |
| description | Abstract Background Anemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb-mass) and the response to intravenous iron in anemic patients prior to surgery. Methods A prospective clinical study was undertaken in patients having routine cardiopulmonary exercise testing (CPET) with a hemoglobin concentration ([Hb]) < 130 g.l−1 and iron deficiency/depletion. Patients underwent CPET and tHb-mass measurements before and a minimum of 14 days after receiving intravenous (i.v.) Ferric derisomaltose (Monofer®) at the baseline visit. Comparative analysis of hematological and CPET variables was performed pre and post-iron treatment. Results Twenty-six subjects were recruited, of whom 6 withdrew prior to study completion. The remaining 20 (9 [45%] male; mean ± SD age 68 ± 10 years) were assessed 25 ± 7 days between baseline and the final visit. Following i.v. iron, increases were seen in [Hb] (mean ± SD) from 109 ± 14 to 116 ± 12 g l−1 (mean rise 6.4% or 7.3 g l−1, p = < 0.0001, 95% CI 4.5–10.1); tHb-mass from 497 ± 134 to 546 ± 139 g (mean rise 9.3% or 49 g, p = < 0.0001, 95% CI 29.4–69.2). Oxygen consumption at anerobic threshold ( $$\dot{\text{V}}$$ V ˙ O2 AT) did not change (9.1 ± 1.7 to 9.8 ± 2.5 ml kg−1 min−1, p = 0.09, 95% CI − 0.13 − 1.3). Peak oxygen consumption ( $$\dot{\text{V}}$$ V ˙ O2 peak) increased from 15.2 ± 4.1 to 16 ± 4.4 ml.kg.−1 min−1, p = 0.02, 95% CI 0.2–1.8) and peak work rate increased from 93 [67–112] watts to 96 [68–122] watts (p = 0.02, 95% CI 1.3–10.8). Conclusion Preoperative administration of intravenous iron to iron-deficient/deplete anemic patients is associated with increases in [Hb], tHb-mass, peak oxygen consumption, and peak work rate. Further appropriately powered prospective studies are required to ascertain whether improvements in tHb-mass and performance in turn lead to reductions in perioperative morbidity. Trial registration ClinicalTrials.gov identifier: NCT 033 46213. |
| first_indexed | 2024-03-13T00:40:43Z |
| format | Article |
| id | doaj.art-7e509423b0044b169b2a8a30f4610f90 |
| institution | Directory Open Access Journal |
| issn | 2047-0525 |
| language | English |
| last_indexed | 2024-03-13T00:40:43Z |
| publishDate | 2023-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Perioperative Medicine |
| spelling | doaj.art-7e509423b0044b169b2a8a30f4610f902023-07-09T11:19:54ZengBMCPerioperative Medicine2047-05252023-07-0112111410.1186/s13741-023-00319-xCardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical studyJames O. M. Plumb0James M. Otto1Shriya B. Kumar2Sitara Bali3Mai Wakatsuki4Walter F. J. Schmidt5Hugh E. Montgomery6Michael P. W. Grocott7Denny Z. Levett8Perioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of SouthamptonPerioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of SouthamptonPerioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of SouthamptonPerioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of SouthamptonShackleton Department of Anaesthesia, University Hospital Southampton NHSFTDepartment of, Sports Medicine/Sports Physiology, University of BayreuthCentre for Human Health and Performance/Institute of Sport, Exercise and Health, University College LondonPerioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of SouthamptonPerioperative and Critical Care Theme, NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust/University of SouthamptonAbstract Background Anemia is associated with impaired physical performance and adverse perioperative outcomes. Iron-deficiency anemia is increasingly treated with intravenous iron before elective surgery. We explored the relationship between exercise capacity, anemia, and total hemoglobin mass (tHb-mass) and the response to intravenous iron in anemic patients prior to surgery. Methods A prospective clinical study was undertaken in patients having routine cardiopulmonary exercise testing (CPET) with a hemoglobin concentration ([Hb]) < 130 g.l−1 and iron deficiency/depletion. Patients underwent CPET and tHb-mass measurements before and a minimum of 14 days after receiving intravenous (i.v.) Ferric derisomaltose (Monofer®) at the baseline visit. Comparative analysis of hematological and CPET variables was performed pre and post-iron treatment. Results Twenty-six subjects were recruited, of whom 6 withdrew prior to study completion. The remaining 20 (9 [45%] male; mean ± SD age 68 ± 10 years) were assessed 25 ± 7 days between baseline and the final visit. Following i.v. iron, increases were seen in [Hb] (mean ± SD) from 109 ± 14 to 116 ± 12 g l−1 (mean rise 6.4% or 7.3 g l−1, p = < 0.0001, 95% CI 4.5–10.1); tHb-mass from 497 ± 134 to 546 ± 139 g (mean rise 9.3% or 49 g, p = < 0.0001, 95% CI 29.4–69.2). Oxygen consumption at anerobic threshold ( $$\dot{\text{V}}$$ V ˙ O2 AT) did not change (9.1 ± 1.7 to 9.8 ± 2.5 ml kg−1 min−1, p = 0.09, 95% CI − 0.13 − 1.3). Peak oxygen consumption ( $$\dot{\text{V}}$$ V ˙ O2 peak) increased from 15.2 ± 4.1 to 16 ± 4.4 ml.kg.−1 min−1, p = 0.02, 95% CI 0.2–1.8) and peak work rate increased from 93 [67–112] watts to 96 [68–122] watts (p = 0.02, 95% CI 1.3–10.8). Conclusion Preoperative administration of intravenous iron to iron-deficient/deplete anemic patients is associated with increases in [Hb], tHb-mass, peak oxygen consumption, and peak work rate. Further appropriately powered prospective studies are required to ascertain whether improvements in tHb-mass and performance in turn lead to reductions in perioperative morbidity. Trial registration ClinicalTrials.gov identifier: NCT 033 46213.https://doi.org/10.1186/s13741-023-00319-xAnemiaIntravenous ironCardiopulmonary exercise testingCPETTotal hemoglobin masstHb-mass |
| spellingShingle | James O. M. Plumb James M. Otto Shriya B. Kumar Sitara Bali Mai Wakatsuki Walter F. J. Schmidt Hugh E. Montgomery Michael P. W. Grocott Denny Z. Levett Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study Perioperative Medicine Anemia Intravenous iron Cardiopulmonary exercise testing CPET Total hemoglobin mass tHb-mass |
| title | Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study |
| title_full | Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study |
| title_fullStr | Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study |
| title_full_unstemmed | Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study |
| title_short | Cardiopulmonary exercise testing before and after intravenous iron in preoperative patients: a prospective clinical study |
| title_sort | cardiopulmonary exercise testing before and after intravenous iron in preoperative patients a prospective clinical study |
| topic | Anemia Intravenous iron Cardiopulmonary exercise testing CPET Total hemoglobin mass tHb-mass |
| url | https://doi.org/10.1186/s13741-023-00319-x |
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