New possibilities of pathogenetic correction of anemia in chronic heart failure

If chronic heart failure (CHF) is accompanied by anemic syndrome and iron defi ciency (ID) tolerance to treatment develops, the eff ectiveness of drugs that form the basis of CHF treatment decreases, and the prognosis worsens. Aim. To evaluate the possibilities of using iron preparations with hepcidin-independent absorption mechanism depending on the characteristics of iron metabolism, erythropoiesis and the level of infl ammation in patients with CHF and anemia. Material and methods. The study included 68 patients diagnosed with CHF to describe the characteristics of anemia (General group). Further, 56 patients who signed consent to the study were divided into two groups: 30 patients (Treatment Group) with standard CHF therapy and iron preparations, and 26 (Comparison Group) with standard CHF therapy only. Sucrosomial iron (SI) was used 60 mg per day orally for three months. Results. Variants of anemia in CHF: absolute ID (AID) — 43%, functional ID (FID) — 19%, anemia without ID — 38%. In the treatment group, an increase in hemoglobin (Hb, p < 0.002), hematocrit (Ht, p < 0.001), mean corpuscular volume (MCV, p < 0.002) and serum ferritin (SF, p < 0.05), in the Сomparison group only Ht, p < 0.01, and the greatest increase in Hb was detected in patients with SF < 30 μmol/l (p < 0.002). Conclusion. Anemia in CHF corresponds to the signs of anemia of chronic disease (ACD) with J, while J was detected in 62% of patients. The use of SI signifi cantly increases erythrocyte counts and SF/

1. Zahidova K.K. The choice of optimal therapy for the correction of anemic syndrome in patients with chronic heart failure. Cardiology. 2018;58(1):25–31. (In Russian). DOI: 10.18087/cardio.2018.1.10076

2. Tkachenko E.I., Borovkova N.Y., Buya nova M.V. Anemia in chronic heart failure: a look at the pathogenesis and ways of correction. Doctor.Ru. 2019;2(157):31–36. (In Russian). DOI: 10.31550/1727-2378-2019-157-2-31-36

3. Anand I.S., Gupta P. Anemia and iron defi ciency in heart failure: current concepts and emerging therapies. Circulation. 2018;138.1:80– 98. DOI: 10.1161/CIRCULATIONAHA.118.030099

4. Vatutin N.T., Taradin G.G., Kanisheva I.V., Venzheha V.V. Anaemia and iron defi ciency in chronic heart failure patients. Kardiologiia. 2019;59(4S):4–20. (In Russian). DOI: 10.18087/cardio.2638

5. Silverberg D.S., Wexler D., Schwartz D. Is correction of iron defi ciency a new addition to the treatment of the heart failure? International Journal of Molecular Sciences. 2015;16.6:14056– 14074. DOI: 10.3390/ijms160614056

6. Ezekowitz J.A., O’Meara E., McDonald M.A. et al. Comprehensive update of the Canadian Cardiovascular Society guidelines for the management of heart failure. Canadian Journal of Cardiology. 2017;33(11):1342–1433. DOI: 10.1016/j.cjca.2017.08.022

7. Stuklov N.I. Iron deficiency and anemia in patients with chronic heart failure. Ration. Рharmacotherapy in cardiology. 2017;13(5):651–60. (In Russian). DOI: 10.20996/1819-6446-2017-13-5-651-660

8. Rukavitsyn O.A. Anemia. 2nd ed., revised. and additional. M.: GEOTAR-Media. 2016: 250. (In Russian). ISBN 978-5-9704-4475-7

9. Pozzo J., Fournier P., Delmas C.et al. Absolute iron deficiency without anaemia in patients with chronic systolic heart failure is associated with poorer functional capacity. Arch. Cardiovasc. Dis. 2017;110(2):99–105. DOI: 10.1016/j.acvd.2016.06.003

10. Wong C.C., Ng A.C., Kritharides L., Sindone A.P. Iron deficiency in heart failure: looking beyond anaemia. Heart Lung Circ. 2016;25(3):209–16. DOI: 10.1016/j.hlc.2015.06.827

11. Ponikowski P., Kirwan B.A., Anker S.D. et al. Ferric carboxymaltose for iron defi ciency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial. Lancet. 2020; 396(10266):1895–1904. DOI: 10.1016/S0140-6736(20)32339-4

12. Lewis G.D., Semigran M.J., Givertz M.M. Oral iron therapy for heart failure with reduced ejection fraction: design and rationale for oral iron repletion eff ects on oxygen uptake in heart failure. Circ. Heart Fail. 2016;9(5):e000345. DOI: 10.1161/CIRCHEARTFAILURE.115.000345

13. Zykov M.V., Kashtalap V.V., Bykova I.S., Poltaranina V.A., Barbarash O.L., Raff S.A., Kosmacheva E.D., Erlix A.D. Comorbidity in myocardial infarction complicated by acute heart failure. Russian journal of cardiology. 2020;25(7):87–94. (In Russian). DOI: 10.15829/1560-4071-2020-3427

14. Akimova A.V., Nevskaya A.V., Milashchenko A.I. Features of anemia of chronic diseases in a therapeutic hospital. Bulletin of the Ural medical academic science. 2018;15(1):5–11. (In Russian). DOI: 10.22138/2500-0918-2018-15-1-5-11

15. Rukavitsyn O.A. Anemia of chronic diseases: some aspects of pathogenesis and ways of correction. Oncohematology. 2016;11(1):37–46. (In Russian). DOI 10.17650/1818-8346-2016-11-1-37-46

16. Solomakhina N.I., Nakhodnova E.S., Gitel E.P., Belenkov Y.N. Hepcidin and its relationship with infl ammation in old and older patients with anemia of chronic disease associated with CHF. Kardiologiia. 2018;(S2):4– 11. (In Russian). DOI: 10.18087/cardio.2457

17. Anker S.D., Kirwan B.A., van Veldhuisen D.J. et al. Effects of ferric carboxymaltose on hospitalisations and mortality rates in iron-deficient heart failure patients: an individual patient data metaanalysis. Eur. J. Heart Fail. 2018;20(1):125–133. DOI: 10.1002/ejhf.823

18. Chronic heart failure. Clinical guidelines 2020. Russian Journal of Cardiology. 2020;25(11):4083. (In Russian). DOI: 10.15829/1560-4071-2020-4083

19. Zykov M.V., Kashtalap V.V., Bykova I.S. Association of multimorbidity with the risk of developing cardiovascular complications in patients with acute coronary syndrome. Cardiology Bulletin. 2018;13(2):59–65. (In Russian). DOI 10.17116/Cardiobulletin201813259

20. Shlyakhto E.V. Cardiology. National leadership. Short edition. Ed. E. V. Shlyakhto. 2nd ed., revised. and additional. M.: GEOTAR-Media. 2018:816. (In Russian). ISBN: 978-5-9704-4387-3