Eisenmangel bei chronischer Herzinsuffizienz

Zusammenfassung

Eisenmangel bei chronischer Herzinsuffizienz ist ein bedeutsamer Risikoparameter, der die körperliche Leistungsfähigkeit und die Lebensqualität der Patienten negativ beeinflusst. Zahlreiche Studien bzw. Metaanalysen legen nahe, dass eine parenterale Eisensubstitution – im Gegensatz zur oralen Therapie – einen positiven Effekt auf Morbidität, Mortalität, Hospitalisierungsraten und Lebensqualität hat. Zudem scheint die parenterale Eisengabe auch einen ökonomischen Benefit zu haben. Einige neu aufgelegte Studien werden zusätzliche Erkenntnisse zutage bringen und die Empfehlungen für eine intravenöse Eisengabe bei diesem speziellen Patientengut untermauern.

• Literatur

• 1 Klip IT, Comin-Colet J, Voors AA. et al. Iron deficiency in chronic heart failure: an international pooled analysis. Am Heart J 2013; 165: 575-582
• 2 Ponikowski P, Voors AA, Anker SD. et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18: 891-975
• 3 Qunibi WY. The efficacy and safety of current intravenous iron preparations for the management of iron-deficiency anaemia: a review. Arzneimittelforschung 2010; 60: 399-412
• 4 Horl WH. Clinical Aspects of Iron Use in the Anemia of Kidney Disease. J Am Soc Nephrol 2007; 18: 382-393
• 5 Kaitha S, Bashir M, Ali T. Iron deficiency anemia in inflammatory bowel disease. World J Gastrointest Pathophysiol 2015; 6: 62-72
• 6 Mozzafarian D, Benjamin EJ, Go AS. et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics – 2016 update: a report from the American Heart Association. Circulation 2016; 133: e38-e360
• 7 Zugck C, Müller A, Helms TM. et al. Gesundheitsökonomische Bedeutung der Herzinsuffizienz: Analyse bundesweiter Daten. Dtsch Med Wochenschr 2010; 135: 633-638
• 8 Stewart S, Macintyre K, Hole DJ. et al. More malignant than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 2001; 3: 315-322
• 9 Pani L, Pecorelli S, Rosano G. et al. Steps forward in regulatory pathways for acute and chronic heart failure. ESC Heart Failure 2014; 1: 87-93
• 10 von Haehling S, Anker MS, Anker SD. Prevalence and clinical impact of cachexia in chronic illness in Europe, USA, and Japan: facts and numbers update 2016. J Cachexia Sarcopenia Muscle 2016; 7: 507-509
• 11 von Haehling S, Ebner N, Dos Santos MR. et al. Muscle wasting and cachexia in heart failure: mechanisms and therapies. Nat Rev Cardiol 2017; 14: 323-341
• 12 Konishi M, Ishida J, Springer J. et al. Cachexia research in Japan: facts and numbers on prevalence, incidence and clinical impact. Journal of Cachexia, Sarcopenia and Muscle 2016; 7: 515-519
• 13 Boengler K, Kosiol M, Mayr M. et al. Mitochondria and ageing: role in heart, skeletal muscle and adipose tissue. Journal of Cachexia, Sarcopenia and Muscle 2017; 8: 349-369
• 14 Sajeev CG, Nair SR, George B. et al. Demographical and clinicopathological characteristics in heart failure and outcome predictors: a prospective, observational study. ESC Heart Failure 2017; 4: 16-22
• 15 Enjuanes C, bruguera J, Grau M. et al. Iron Status in Chronic Heart Failure: Impact on Symptoms, Functional Class and Submaximal Exercise Capacity. Rev Esp Cardiol 2016; 69: 247-255
• 16 von Haehling S, Gremmler U, Krumm M. et al. Prevalence and clinical impact of iron deficiency and anaemia among outpatients with chronic heart failure: The PrEP Registry. Clin Res Cardiol 2017; 106: 436-443
• 17 Arora NP, Ghali JK. Iron deficiency anemia in heart failure. Heart Fail Rev 2013; 18: 485-501
• 18 Jankowska EA, von Haehling S, Anker SD. et al. Iron deficiency and heart failure: diagnostic dilemmas and therapeutic perspectives. Eur Heart J 2013; 34: 816-829
• 19 von Haehling S, Jankowska EA, van Veldhuisen DJ. et al. Iron deficiency and cardiovascular disease. Nat Rev Cardiol 2015; 12: 659-669
• 20 Beard JL. Iron biology in immune function, muscle metabolism and neuronal functioning. J Nutr 2001; 131: 568-579
• 21 Haas JD, Brownlie T. Iron deficiency and reduced work capacity: a critical review to determine a causal relationship. J Nutr 2001; 131 (Suppl. 02) 676S-688S
• 22 Jankowska EA, Rozentryt P, Witkowska A. et al. Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure. J Card Fail 2011; 17: 899-906
• 23 Núñez J, Monmeneu JV, Mollar A. et al. Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study. ESC Heart Failure 2016; 3: 293-298
• 24 Haddad S, Wang Y, Galy B. et al. Iron-regulatory proteins secure iron availability in cardiomyocytes to prevent heart failure. Eur Heart J 2017; 38: 362-372
• 25 Ebner N, Jankowska EA, Ponikowski P. et al. The impact of iron deficiency and anaemia on exercise capacity and outcomes in patients with chronic heart failure. Results from the Studies Investigating Co-morbidities Aggravating Heart Failure. Int J Cardiol 2016; 205: 6-12
• 26 McMurray JJ, Adamopoulos S, Anker SD. et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2012; 14: 803-869
• 27 Ponikowski P, van Veldhuisen DJ, Comin-Colet J. et al. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. Eur Heart J 2015; 36: 657-668
• 28 Jankowska EA, Rozentryt P, Witkowska A. et al. Iron deficiency: an ominous sign in patients with systolic chronic heart failure. Eur Heart J 2010; 31: 1872-1880
• 29 Ponikowska M, Tupikowska M, Kasztura M. et al. Deranged iron status in psoriasis: the impact of low body mass. J Cachexia Sarcopenia Muscle 2015; 6: 358-364
• 30 Hasenfuß G. et al. ESC POCKET GUIDELINES – Leitlinien für die Diagnose und Behandlung der akuten und chronischen Herzinsuffizienz. Herausgeber: Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e. V.; 2012
• 31 Lewis GD, Malhotra R, Hernandez AF. et al. NHLBI Heart Failure Clinical Research Network. Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial. JAMA 2017; 317: 1958-1966
• 32 Geisser P, Burckhardt S. The pharmacokinetics and pharmacodynamics of iron preparations. Pharmaceutics 2011; 3: 12-33
• 33 Hastka J, Heimpel H, Metzgeroth G. Eisenmangel und Eisenmangelanämie. Leitlinie der Deutschen Gesellschaft für Hämatologie und Onkologie (DGHO). 2011 http://www.dgho-onkopedia.de/onkopedia/leitlinien/eisenmangel-und-eisenmangelanaemie
• 34 Okonko DO, Grzeslo A, Witkowski T. et al. Effect of intravenous iron sucrose on exercise tolerance in anemic and nonanemic patients with symptomatic chronic heart failure and iron deficiency FERRIC-HF: a randomized, controlled, observer-blinded trial. J Am Coll Cardiol 2008; 51: 103-112
• 35 Bolger AP, Bartlett FR, Penston HS. et al. Intravenous iron alone for the treatment of anemia in patients with chronic heart failure. J Am Coll Cardiol 2006; 48: 1225-1227
• 36 Toblli JE, Lombra a A, Duarte P. et al. Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol 2007; 50: 1657-1665
• 37 Toblli JE, Di Gennaro FP. Hospitalization and mortality in elderly cardio-renal patients with iron deficiency anemia receiving intravenous iron therapy: a five year follow-up from a pilot study. Circulation 2012; 126 A16373
• 38 Jankowska EA, Tkaczyszyn M, Suchocki T. et al. Effects of intravenous iron therapy in iron-deficient patients with systolic heart failure: a meta-analysis of randomized controlled trials. Eur J Heart Fail 2016; 18: 786-795
• 39 Anker SD, Comin Colet J, Filippatos G. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med 2009; 361: 2436-2448
• 40 Ponikowski P, Fillipatos G, Colet JC. The impact of intravenous ferric carboxymaltose on renal function: an analysis of the FAIR-HF study. Eur Heart J 2015; 17: 329-339
• 41 Van Veldhuisen DJ, Ponikowski P, Metra M. et al. Effect of ferric carboxymaltose on exercise capacity in patients with iron deficiency and chronic heart failure (EFFECT-HF): A randomized controlled study. American Heart Association 2016 Scientific Sessions; November 16, 2016. New Orleans:
• 42 Lewis GD. Oral Iron Repletion Effects On Oxygen Uptake in Heart Failure (IRONOUT). American Heart Association 2016 Scientific Sessions; November 16, 2016. New Orleans: https://www.clinicaltrials.gov/ct2/show/NCT02188784 Circ Heart Fail 2016; 9:e000345
• 43 Anker SD, Kinwan BA, van Veldhuisen DJ. et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data meta-analysis. Eur J Heart Fail. 2017 Apr 24. doi: 10.1002/ejhf.823 [Epub ahead of print]
• 44 Clark AL, Pellicori P. Clinical trials update from the European Society of Cardiology meeting 2014: PARADIGM-HF, CONFIRMHF, SIGNIFY, atrial fibrillation, beta-blockers and heart failure, and vagal stimulation in heart failure. ESC Heart Failure 2014; 1: 82-86
• 45 Theidel U, Väätäinen S, Martikainen J. et al. Budget impact of intravenous iron therapy with ferric carboxymaltose in patients with chronic heart failure and iron deficiency in Germany. ESC Heart Fail 2017; 4: 274-281
• 46 https://fair-hf2.dzhk.de abgerufen am 25.4.17
• 47 https://clinicaltrials.gov/ct2/show/NCT03074591 abgerufen am 25.4.17
• 48 https://clinicaltrials.gov/ct2/show/NCT02937454 abgerufen am 25.4.17
• 49 https://clinicaltrials.gov/ct2/show/NCT02642562 abgerufen am 25.4.17
• 50 https://clinicaltrials.gov/ct2/show/NCT03037931 abgerufen am 25.4.17
• 51 Yeo TJ, Yeo PSD, Hadi FA. et al. Rationale and design of a pilot randomized controlled trial to assess the role of intravenous ferric carboxymaltose in Asian patients with heart failure (PRACTICE-ASIA-HF). ESC Heart Fail 2016; 3: 71-76
• 52 Anker SD, Colet JC, Filippatos G. et al. FAIR-HF committees and investigators. Rationale and design of Ferinject assessment in patients with IRon deficiency and chronic Heart Failure (FAIR-HF) study: a randomized, placebo-controlled study of intravenous iron supplementation in patients with and without anaemia. Eur J Heart Fail 2009; 11: 1084-1091