Author(s):
Ramos, Raúl ; Ras Jimenez, Maria Del Mar ; Basalo Carbajales, María Del Carmen ; Jovells Vaqué, Sílvia ; GARCIA-PINILLA, JOSE MANUEL ; Cobo-Marcos, Marta ; De Juan Baguda, Javier ; Fonseca, Cândida ; Francesch Manzano, Josep ; Cosa, Andreea Eunice ; Yun, Sergi ; Enjuanes, Cristina ; Tajes Orduña, Marta ; Comin-Colet, Josep
Date: 2025
Persistent ID: http://hdl.handle.net/10362/184918
Origin: Repositório Institucional da UNL
Subject(s): chronic heart failure; comorbidities; echocardiography; iron deficiency; myocardial work; Medicine(all)
Description
Funding Information: The IRON-PATH II study was sponsored by CSL Vifor with coordination by Bellvitge Biomedical Research Institute (IDIBELL). The sponsor did not participate in the design of this study nor data analysis. An independent data and safety monitoring committee reviewed the data every 6 months. This study was approved by the local ethics committees for clinical research at each participating center and was conducted in accordance with the principles of the Declaration of Helsinki. All the patients gave written informed consent before entering this study. Funding Information: The authors kindly acknowledge all participants in the IRON-PATH II study. We thank CERCA Programme/Generalitat de Catalunya for their institutional support. We thank the Departament de Salut de la Generalitat de Catalunya through \u201CPla Estrat\u00E8gic de Recerca i Innovaci\u00F3 en Salut (PERIS 2023)\u201D grant number SLT028/23/000018 for financial support. Furthermore, we are grateful to the Centro de Investigaci\u00F3n Biom\u00E9dica en Red de Enfermedades Cardiovasculares (CIBERCV) for their institutional and financial support. Funding Information: This research received an unrestricted grant from CSL Vifor (Sponsor Reference IS-HUB-004/21 (IRON PATH II). Publisher Copyright: © 2025 by the authors.
Background: Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to ID may lead to cardiac function abnormalities, that can be reversible after iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW) and its derivatives constructive work (CW), wasted work (WW) and work efficiency (WE), may be of added value in advanced cardiac performance assessment. Methods: IRON-PATH II was a multicenter, prospective and observational study designed to describe the pathophysiological pathways associated with ID. The echo-substudy included 100 HF patients that had undergone a specific pilot echocardiographic evaluation. Patients had a left ventricular ejection fraction (LVEF) ≤50%, were in stable clinical condition and on standard HF medication with hemoglobin ≥11 g/dL. The final cohort included 98 patients. Results: The ID group showed worse cardiac function, with lower GLS (−8.5 ± 9% vs. −10 ± 10%), WE (74 ± 10% vs. 80 ± 10%) and MW (665 [453–1013] vs. 947 [542–1199] mmHg%), as well as higher WW (290 [228–384] vs. 212 [138–305] mmHg%) and lower RV free wall strain (−13 [−20–(−11)]% vs. −17 [−23–(−14)]%). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all p-values >0.05 compared to the non-ID group). Conclusions: Among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV. All the alterations seen were reversible after intravenous iron repletion.
