title: Positive effect of intravenous iron-oxide administration on left ventricular remodelling in patients with acute ST-elevation myocardial infarction - a cardiovascular magnetic resonance (CMR) study.
abstract: OBJECTIVE
  This study investigated the safety profile and potential "therapeutic" effect of intravenous ultrasmall superparamagnetic iron-oxide (USPIO)-based iron administration regarding infarct healing in patients with ST-elevation myocardial infarction (STEMI). USPIO-administration was recently shown to enable an improved characterization of myocardial infarct pathology in acute STEMI patients.
  
  
  METHODS
  Seventeen study patients (IRON, 54 ± 9 yrs, 88% male) and 22 matched controls (CONTROL, 57 ± 9 yrs, 77% male) both with primary reperfused STEMI underwent multi-parametric CMR studies in the first week and three months after acute MI. Only IRON patients received a single intravenous bolus of 510 mg elemental iron as ferumoxytol (Feraheme(TM)) within four days following acute MI.
  
  
  RESULTS
  Three months later, all patients were alive and there were no adverse cardiac events. Significant improvement in left ventricular (LV) ejection fraction (IRON: 53 ± 10% to 59 ± 9%, p=0.002;
  
  
  METHODS
  54 ± 6% to 57 ± 10%, p=0.005) as well as shrinkage of infarct size were seen in both groups at follow-up. There was a more pronounced decrease in infarct size in the IRON group (IRON: -10.3 ± 5.4% vs.
  
  
  METHODS
  -7.0 ± 8.4%, p=0.050) in addition to a significant decrease in both endocardial extent and prevalence of transmural infarctions in IRON but not in CONTROL patients. A significant decrease in LV end systolic volume was only seen in the IRON group (71 ± 25 mL to 59 ± 25 mL, p=0.002).
  
  
  CONCLUSIONS
  Intravenous iron administration in acute STEMI patients seems to be associated with an improved infarct healing and a beneficial global left ventricular remodelling. These findings together with the good safety profile make USPIO-based iron administration a promising future candidate as a "diagnostic" and "therapeutic" adjunctive solution in acute MI management.
authors.affiliation: Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany.
authors.forename: Anca
authors.initials: A
authors.lastname: Florian
authors.affiliation: Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Anna
authors.initials: A
authors.lastname: Ludwig
authors.affiliation: Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Sabine
authors.initials: S
authors.lastname: Rösch
authors.affiliation: Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Handan
authors.initials: H
authors.lastname: Yildiz
authors.affiliation: Pharmacy, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Klumpp
authors.affiliation: Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany. Electronic address: ali.yilmaz@ukmuenster.de.
authors.forename: Ali
authors.initials: A
authors.lastname: Yilmaz
mesh_terms: D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects; D003911:Dextrans / Q000008:administration & dosage* / Q000009:adverse effects*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D019028:Magnetic Resonance Imaging, Cine; D058185:Magnetite Nanoparticles / Q000008:administration & dosage* / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000187:drug effects; D020257:Ventricular Remodeling / Q000187:drug effects*
chemical_list: D003287:Contrast Media; D003911:Dextrans; D058185:Magnetite Nanoparticles; C097921:ferumoxtran-10
keywords: CMR; Ferumoxytol; LGE; Myocardial infarction; USPIO; Ventricular remodelling