title: Left ventricular ejection fraction recovery in patients with heart failure treated with intravenous iron: a pilot study.
abstract: OBJECTIVE
  In 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).
  
  
  RESULTS
  In 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,R2(partial): 0.748,P= 0.012]. A median regression analysis backed-up these findings.
  
  
  CONCLUSIONS
  In 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.
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.affiliation: Unidad de Imagen Cardiaca (ERESA) Hospital Clínico Universitario de Valencia Valencia Spain.
authors.forename: José Vicente
authors.initials: JV
authors.lastname: Monmeneu
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Mollar
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Santas
authors.affiliation: Department of Epidemiology, Atherothrombosis and Imaging Department Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC) Madrid Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Agüero
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.affiliation: Cardiology Department, Hospital Clínico Universitario, INCLIVA Universitat de Valencia Valencia Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.affiliation: Unidad de Imagen Cardiaca (ERESA) Hospital Clínico Universitario de Valencia Valencia Spain.
authors.forename: Maria Pilar
authors.initials: MP
authors.lastname: López-Lereu
keywords: Intravenous iron; Iron deficiency; Left ventricular ejection fraction; Magnetic resonance imaging; Systolic heart failure; T2* sequence