Parenteral Iron Supplementation, Chemoreflex Response, Quality of Life And Exercise Capacity In Patients With ChronicHeart Failure

Background: it has been recently recognized that patients with chronic heart failure (CHF) often present with anemia (AN) and a disordered iron homeostasis, i.e. absolute or relative iron deficiency (ID). The etiopathogenesis of AN and ID in CHF is thought to be multifactorial and its diagnosis possibly challenging, the laboratory parameters of iron metabolism being alte-red in the course of CHF as a consequence of CHF itself, inflammation and chronic renal failure. Moreover, the presence of ID, associated or not with AN, is an ominous sign in CHF patients, impacting on symptoms and quality of life, adversely af-fecting the clinical outcome. I.v. iron therapy (IIT) in CHF with possible ID has been recently proven safe and effective for clinical improvement, which has been attributed both to the correction of AN and to improved cellular oxidative metabolism.
However, many unanswered questions still surround this field of interest, and guidelines specifically addressing the diagnosis and treatment of ID in patients with CHF are still lacking. On the other hand, CHF patients also present with imbalanced pe-ripheral chemosensitivity (PC) and central chemosensitivity (CC),which can account for dyspnea and exercise intolerance and which may have prognostic significance. PC is partially dependent on heme-containing proteins in carotid glomus cells and indirect data may suggest that also CC may be influenced by body iron stores.


Aims: to test the hypothesis that IIT in anemic patients with CHF and absolute or relative ID could result in improvement of PC,CC and clinical conditions. An additional aim is to assess possible relationships between changes in laboratory parame-ters of iron metabolism and functional responses to such therapy. A final aim is to better characterize the behaviour of iron metabolism, in particular the role played by hepcidin, in patients with chronic HF undergoing IIT.

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