Quantification of Myocardial Iron Deficiency in Nonischemic Heart Failure by Cardiac T2* Magnetic Resonance Imaging

Nagao, Michinobu; Matsuo, Yoshio; Kamitani, Takeshi; Yonezawa, Masato; Yamasaki, Yoshio; Kawanami, Satoshi; Abe, Kohtaro; Mukai, Yasushi; Higo, Taiki; Yabuuchi, Hidetake; Takemura, Akihiro; Yamada, Takashi; Sunagawa, Kenji; Honda, Hiroshi

doi:10.1016/j.amjcard.2013.11.061

Cited by 27 publications

(24 citation statements)

References 11 publications

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“…Cardiac magnetic resonance (CMR) T2* sequence has emerged as a reliable non‐invasive technique for assessing myocardial iron overload 7, 8. Recently, this technique has also shown a potential utility for evaluating myocardial iron deficiency 9, 10…”

Section: Introductionmentioning

confidence: 99%

“…7,8 Recently, this technique has also shown a potential utility for evaluating myocardial iron deficiency. 9,10 Aims We aimed to evaluate whether (i) T2* sequence significantly changes after intravenous iron administration in patients with ID with HFrEF, and (ii) if such changes correlate with simultaneous changes in CMR LV systolic function.…”

Section: Introductionmentioning

confidence: 99%

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Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

et al. 2016

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AimsIn patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency, treatment with intravenous iron has shown a clinical improvement regardless of anaemic status. Cardiac magnetic resonance (CMR) T2* sequence has shown a potential utility for evaluating myocardial iron deficiency. We aimed to evaluate whether T2* sequence significantly changes after ferric carboximaltose (FCM) administration, and if such changes correlate with changes in left ventricle ejection fraction (LVEF).Methods and resultsIn this pilot study, we included eight patients with chronic symptomatic (New York Heart Association II–III) HFrEF and iron deficiency. A CMR, including T2* analysis, was performed before and at a median of 43 days (interquartile range = 35–48) after intravenous FCM administration. Pearson or Spearman correlation coefficient (r) was used for bivariate contrast as appropriate. A partial correlation analysis was performed between ΔLVEF and ΔT2* while controlling for anaemia status at baseline. Anaemia was present in half of patients. After FCM administration, T2* decreased from a median of 39.5 (35.9–48) to 32 ms (32–34.5), P = 0.012. Simultaneously, a borderline increase in median of LVEF [40% (36–44.5) to 48.5% (38.5–53), P = 0.091] was registered. In a bivariate correlational analysis, ΔT2* was highly correlated with ΔLVEF (r = −0.747, P = 0.033). After controlling for anaemia at baseline, the association between ΔT2* and ΔLVEF persisted [r(partial): −0.865, R 2(partial): 0.748, P = 0.012]. A median regression analysis backed‐up these findings.ConclusionsIn a small sample of patients with HFrEF and iron deficiency, myocardial iron repletion assessed by CMR was associated to left ventricular remodelling. Further studies are warranted.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

et al. 2016

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“…Cardiac magnetic resonance imaging studies show that low myocardial iron (as measured by myocardial T2* imaging) was associated with non-ischaemic heart failure (Nagao et al, 2014(Nagao et al, , 2015 While there may be multiple pathways through which iron deficiency can impair cardiac function, tissue Doppler and strain rate measurements show significant improvements in diastolic and systolic myocardial function in iron-deficient patients after iron replacement therapy (Gaber et al, 2012).…”

Section: Pathophysiology Of Iron Deficiency In the Failing Heartmentioning

confidence: 99%

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Makubi

Roberts

2017

Br J Haematol

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Summary Frank iron deficiency has been associated with a wide range of cardiac and pulmonary abnormalities including non‐ischaemic cardiomyopathy. Iron deficiency anaemia and isolated iron deficiency are well‐defined adverse prognostic factors in non‐ischaemic cardiac failure. Furthermore, iron‐deficient patients in chronic heart failure with a serum ferritin of <100 μg/l or <300 μg/l with reduced transferrin saturation of <20%, who were given intravenous iron showed improved clinical outcomes. Iron deficiency with or without anaemia affects over a quarter of the world's population, but the impact of iron deficiency in heart failure and the effective management of iron deficiency in heart failure in Lower and Middle Income Countries (LMICs) is not well described. Heart failure in African cohorts occurs at a younger age than in North America and Europe and is more likely to be due to hypertension. Recent studies suggest that iron deficiency anaemia, which is very common in heart failure patients in Africa, and iron deficiency are independently associated with a poor prognosis in heart failure. Preliminary data suggest that iron deficiency in patients with heart failure can be treated with oral iron, with significant beneficial effects on haematological and physiological variables. Cost may prohibit the use of intravenous iron on a large scale in LMICs and optimal regimes to treat iron deficiency in heart failure patients with oral iron therapy remain to be defined.

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“…36, 37 In a recent study of patients with non-ischemic cardiomyopathy, reduced myocardial iron content (as defined by MRI-based T2 star values in excess of 25) was associated with increased LVEDV, decreased LVEF, and poorer outcomes. 38 Based on the multiple deleterious effects of iron deficiency on cardiac and peripheral performance, iron deficiency represents an attractive target to improve functional capacity in HF patients.…”

Section: Iron Homeostasis In Heart Failurementioning

confidence: 99%

Oral Iron Therapy for Heart Failure With Reduced Ejection Fraction

Lewis

Semigran

Givertz

et al. 2016

Circ: Heart Failure

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Iron deficiency is present in ∼50% of patients with heart failure (HF) and is an independent predictor of mortality. Despite growing recognition of the functional and prognostic significance of iron deficiency, randomized multicenter trials exploring the utility of oral iron supplementation in HF, a therapy that is inexpensive, readily available, and safe, have not been performed. Moreover, patient characteristics that influence responsiveness to oral iron in patients with HF have not been defined. Although results of intravenous iron repletion trials have been promising, regularly treating patients with intravenous iron products is both expensive and poses logistical challenges for outpatients. Herein we describe the rationale for the Oral Iron Repletion effects ON Oxygen UpTake in Heart Failure (IRONOUT HF) Trial. This National Institute of Health-sponsored trial will investigate oral iron polysaccharide compared to matching placebo with the primary endpoint of change in exercise capacity as measured by peak oxygen consumption at baseline and at 16 weeks

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Quantification of Myocardial Iron Deficiency in Nonischemic Heart Failure by Cardiac T2* Magnetic Resonance Imaging

Cited by 27 publications

References 11 publications

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study

Investigation and treatment for iron deficiency in heart failure: the unmet need in Lower and Middle Income Countries

Oral Iron Therapy for Heart Failure With Reduced Ejection Fraction

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