Iron heart - what do we know and what don't we know?

Gospodarka żelazowa odgrywa fundamentalną rolę w homeostazie organizmu. Niedobór żelaza jest najczęstszym niedoborem pokarmowym na świecie i dotyczy około 1/3 populacji ogólnej, a u osób starszych i ze schorzeniami przewlekłymi jest jeszcze częstszy. Stąd zaburzenia gospodarki żelazowej prowadzą do dysfunkcji w obrębie wszystkich hematopoetycznych linii komórkowych (erytrocytów, komórek odpowiedzi immunologicznej i trombocytów), ale także wiążą się z upośledzeniem funkcjonowania m.in. kardiomiocytów czy miocytów mięśni szkieletowych zużywających znaczne ilości energii. Istnieje wiele nurtujących pytań w obszarze roli żelaza w patogenezie i progresji niewydolności serca. Choć męczliwości mięśni szkieletowych i nietolerancji wysiłku fizycznego w niewydolności serca towarzyszy niedobór żelaza, a suplementacja żelaza takim chorym poprawia funkcję mięśni szkieletowych, niejasne są dokładne mechanizmy tłumaczące te obserwacje kliniczne.Iron metabolism is fundamental for homeostasis of the whole organism. Iron deficiency is the most common nutritional deficiency worldwide that affects more than one-third of the global population, with the highest prevalence in older people and those with chronic diseases. Deregulation of iron metabolism leads to dysfunction not only in all of haematopoetic cell lines (erythrocytes, cells involved in immune response and thrombocytes), but also in cells of high energy demand, such as cardiomyocytes and skeletal myocytes. There are many issues that still need to be addressed in the field of pathogenesis and progression of heart failure. Although skeletal muscle fatigability and exercise intolerance in heart failure is assisted by iron deficiency, and iron supplementation improves muscle function, the exact mechanisms of these clinical observations remain unclear however

Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis

AIMS: Iron deficiency (ID) is a common co-morbidity in patients with heart failure (HF) and has been suggested to be associated with poor prognosis. Recently completed double-blind randomised controlled trials (RCTs) studying HF patients with ID have shown improvements in functional capacity, symptoms and quality of life when treated with i.v. ferric carboxymaltose (FCM). This individual patient data meta-analysis investigates the effect of FCM vs. placebo on recurrent hospitalisations and mortality in HF patients with ID. METHODS AND RESULTS: Individual patient data were extracted from four RCTs comparing FCM with placebo in patients with systolic HF and ID. The main outcome measures were recurrent cardiovascular (CV) hospitalisations and CV mortality. Other outcomes included cause-specific hospitalisations and death. The main analyses of recurrent events were backed up by time-to-first-event analyses. In total, 839 patients, of whom 504 were randomised to FCM, were included. Compared with those taking placebo, patients on FCM had lower rates of recurrent CV hospitalisations and CV mortality [rate ratio 0.59, 95% confidence interval (CI) 0.40-0.88; P = 0.009]. Treatment with FCM also reduced recurrent HF hospitalisations and CV mortality (rate ratio 0.53, 95% CI 0.33-0.86; P = 0.011) and recurrent CV hospitalisations and all-cause mortality (rate ratio 0.60, 95% CI 0.41-0.88; P = 0.009). Time-to-first-event analyses showed similar findings, with somewhat attenuated treatment effects. The administration of i.v. FCM was not associated with an increased risk for adverse events. CONCLUSIONS: Treatment with i.v. FCM was associated with a reduction in recurrent CV hospitalisations in systolic HF patients with ID