Effect of intravenous iron replacement therapy on exercise capacity in iron deficient anemic patients after cardiac surgery

  • Cinzia Nugara Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
  • Giuseppe Vitale Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
  • Giuseppa Caccamo Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.
  • Silvia Sarullo Division of Cardiology, University of Palermo, Italy.
  • Francesco Giallauria Department of Translational Medical Sciences, Division of Internal Medicine, Metabolic and Cardiac Rehabilitation Unit, University of Naples Federico II, Italy.
  • Antonino Di Franco Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York City, NY, United States.
  • Silvia Vitale Medical Biotechnology and Molecular Medicine, University of Palermo, Italy.
  • Filippo M. Sarullo | fsarullo@neomedia.it Cardiovascular Rehabilitation Unit, Buccheri La Ferla Fatebenefratelli Hospital, Palermo, Italy.

Abstract

Iron deficiency (ID) is recognized as an important comorbidity in patients undergoing cardiac surgery; however, it still remains under-diagnosed and under-treated in clinical practice. This study aims at comparing efficacy and the effects on exercise capacity of intravenous ferric carboxymaltose (FCM) versus ferric gluconate (FG) in patients with ID anemia (IDA) resulting from cardiac surgery. We retrospectively analyzed data from our records of in-hospital patients with IDA after cardiac surgery undergoing cardiac rehabilitation. Group I was treated with FG, group II with FCM. Efficacy measures included changes (baseline vs discharge) in hemoglobin (Hb) and in distance traveled at six-minutes walking test (6MWT). Data from 74 in-patients (mean age 67.5±10.4 years, 43% women) were analyzed. At discharge, patients treated with FCM showed higher levels of Hb (11.1±1.2g/dl vs 10.2±1.1 g/dl; p=0.001), greater distance traveled at 6MWT (279.2±108.8 meters vs 236.3±72.7 meters; p=0.048), and lower in-hospital rehabilitation length of stay (20.3±7 vs 25.3±11.7 days; p=0.043) as compared to FG group. At multivariate analysis, the most powerful predictors of Hb increase >1 g/dl at discharge were transferrin levels (p=0.019) and treatment with FCM (p<0.001). FCM replacement therapy and iron serum levels were the most powerful predictors of 6MWT distance improvement (>100 meters) at discharge (p=0.13 and p=0.003, respectively). In patients with IDA following cardiac surgery, intravenous FCM is effective in restoring Hb levels and in improving exercise capacity after cardiac surgery.

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Published
2020-03-03
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Section
Cardiology - Original Articles
Keywords:
Iron deficiency, anemia, cardiac surgery, exercise capacity, ferric carboxymaltose, ferric gluconate
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How to Cite
Nugara, C., Vitale, G., Caccamo, G., Sarullo, S., Giallauria, F., Di Franco, A., Vitale, S., & Sarullo, F. M. (2020). Effect of intravenous iron replacement therapy on exercise capacity in iron deficient anemic patients after cardiac surgery. Monaldi Archives for Chest Disease, 90(1). https://doi.org/10.4081/monaldi.2020.1196