Abstract
According to numerous studies, a high prevalence of iron deficiency (ID) with anaemic syndrome and its association with mortality during chronic heart failure (CHF) have been revealed. Ferrocorrection of anaemia during CHF is important both to improve the clinical condition and to optimize the long-term prognosis of patients. However, the pathogenetic justification is the use of agents that have antihypoxic, antioxidant and membrane-stabilizing effects, except iron preparations, and at the same time exert a regulatory effect on the metabolism of physiologically active compounds and improve the functional condition of patients. The aim. The aim of this study was to identify and compare the effect of oral ferrotherapy and combined use of ferrotherapy with L-carnitine on exercise tolerance (ET) of patients with CHF with reduced ejection fraction of left ventricle (LVEF) with concomitant iron deficiency anemia (IDA) was determined and compared. Materials and methods. The study includes 62 patients with CHF with reduced LVEF FC II-III according to NYHA with IDА. Patients with hypertensive and ischemic etiology of HF took part in the study. Among them, 45 (72.6 %) were men and 17 (27.4 %) were women aged 70.0±0.9 years. Two study groups were formed: in addition to the standard therapy, the patients in the 1st group (n=32) were prescribed oral ferrous sulfate in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid 2 tablets per day for 6 months; the patients in the 2nd group (n=30) received the standard therapy of CHF and not only iron, but also L-carnitine. Results and discussion. The use of two variants of ferrocorrection as an application to the standard treatment of CHF among the total number of studied patients with IDA indicates the sufficient effect both to eliminate the signs of anemia and to eliminate ID. The analysis of the dynamics of the passed test distance with a 6-minute walk in 32 patients with IDA on the background of standard treatment and additional ferrotherapy after 6 months showed an increase of the actual distance by 8.9 % (from 249.4 to 272.3 m, p<0.0001). The analysis of changes in the value of travelled distance among patients with IDA who received combined 6-month ferrotherapy with L-carnitine also revealed a significant positive trend. In addition, the value obtained was significantly higher compared to the results of patients with only additional ferrotherapy, an increase of 19.4 % (from 259.5 to 304.5 m, p<0.0001). Conclusions. The use of metabolic therapy with oral ferrotherapy is accompanied by a greater increase in ET, which is reflected in a significantly longer test distance with a 6-minute walk and greater frequency of decrease of FC of HF among patients, compared with using only iron sulfate ferrocorrection.
Highlights
Today, the question of the importance of iron deficiency (ID) as a new therapeutic goal for reducing symptoms, quality of life (QOL) and prognosis of patients with chronic heart failure (CHF) is rather acute [1, 2].The prevalence of anemia as a manifest form of ID of patients with HF reaches about 30 % in outpatient and about 50 % in hospitalized patients [3]
The use of two variants of ferrocorrection as an application to the standard treatment of CHF among the total number of studied patients with iron deficiency anemia (IDA) indicates the sufficient effect both to eliminate the signs of anemia and to eliminate ID
Comparison of the studied laboratory parameters of patients with IDA after 6 months with different options for additional treatment revealed no difference in the increase in hematological parameters, except for the levels of Hct, which were higher for patients who received additional L-carnitine
Summary
The question of the importance of iron deficiency (ID) as a new therapeutic goal for reducing symptoms, quality of life (QOL) and prognosis of patients with chronic heart failure (CHF) is rather acute [1, 2].The prevalence of anemia as a manifest form of ID of patients with HF reaches about 30 % in outpatient and about 50 % in hospitalized patients [3]. According to the above numbers, it can be concluded that ID is a very common comorbidity of CHF, which is known to be independent of sex, race and left ventricular (LV) ejection fraction (EF) (LVEF) [3], but is related to age [4] and (2019), «EUREKA: Health Sciences» Number 6 increase in functional class (FC) of chronic heart failure according to NYHA classification – at FC III to 33 % and at FC IV to 80 % [5, 6]. Regardless of the variant of iron metabolism disorder that underlies the development of anemia, patients with ID present a significant problem for practical health care since the anemia syndrome during CHF is associated with an increase in mortality and the frequency of hospitalizations of patients [3, 8, 9]. There are compensatory hemodynamic mechanisms that lead to the progression of HF and further reduce ET and clinical condition of patients [5]
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