931Beneficial effect of intravenous iron administration on left ventricular remodelling in patients with acute ST-elevation myocardial infarction – a cardiovascular magnetic resonance (CMR) study

Abstract

Background: The infusion of iron has been associated with improved symptoms, functional capacity, and quality of life in patients with heart failure and chronic myocardial infarction – even in the absence of anemia. Objectives: We aimed to investigate the safety profile and effect of intravenous iron administration on short-term ventricular remodeling in patients with myocardial infarction in the acute setting. Material and methods: Seventeen study patients (IRON, 54 ± 9 yrs, 88% male) and 22 matched controls (CONTROL, 57 ± 9 yrs, 77% male) both with primary reperfused ST-elevation myocardial infarctions (STEMI) underwent cine and late gadolinium enhancement cardiovascular magnetic resonance (CMR) imaging in the first week and three months after the acute event. IRON patients received a unique intravenous bolus of 510 mg elemental iron as ferumoxytol (Feraheme®) in the 24 hours following the first CMR exam. Results: Ferumoxytol administration was well tolerated by all patients, with no adverse events. No significant differences regarding baseline infarct characteristics or ventricular function were present between groups. At 3 months follow-up, all patients were alive, with no new adverse cardiac events. In both groups significant changes in left ventricular ejection fraction (IRON: 53 ± 10 to 59 ± 9%, p = 0.002; CONTROL: 54 ± 6 to 57 ± 10, p = 0.005), LV mass index (IRON: 65, 59-76 gr/m2 to 54, 38-114 gr/m2, p = 0.0006; CONTROL: 65, 58-92 gr/m2 to 62, 49-74 gr/m2, p<0.0001) and infarct size (IRON: 27 ± 8 to 17 ± 9%, p<0.0001; CONTROL: 27 ± 12 to 20 ± 11, p<0.0001) were seen at follow-up with a clear (but non-significant) trend towards a higher increase in ejection fraction and smaller scars in the IRON group. In addition, in IRON but not in CONTROL patients, significant decreases in LV end systolic volume (71 ± 25 to 59 ± 25 mL, p = 0.002) and transmural infarctions (17, 100% to 7, 41%, p = 0.0003) were encountered. Conclusion: Intravenous iron administration in acute STEMI patients is associated with both improved infarct healing and beneficial global left ventricular remodeling compared to controls. Moreover, a good safety profile for iron administration was observed.