Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome

Edgar L W Tay, Ana Peset, Maria Papaphylactou, Ryo Inuzuka, Rafael Alonso-Gonzalez, Georgios Giannakoulas, Aphrodite Tzifa, Sara Goletto, Craig Broberg, Konstantinos Dimopoulos, Michael A. Gatzoulis

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

Introduction: Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population. Methods: Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200 mg thrice-daily. The CAMPHOR QoL questionnaire, 6 minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3 months of treatment. Results: Mean age was 39.9 ± 10.9 years, 80% females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3 months of treatment, hemoglobin (19.0 ± 2.9 g/dL to 20.4 ± 2.7 g/dL, p <0.001), ferritin (13.3 ± 4.7 μg/L to 54.1 ± 24.2 μg/L, p <0.001) and transferrin saturation (17.8 ± 9.6% to 34.8 ± 23.4%, p <0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7 ± 10.9 to 16.2 ± 10.4, p = 0.001) and 6MWT distance (371.7 ± 84.7 m to 402.8.0 ± 74.9 m, p = 0.001). Peak VO 2 remained unchanged (40.7 ± 9.2% to 43.8 ± 12.4% of predicted, p = 0.15). Conclusion: Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.

Original languageEnglish (US)
Pages (from-to)307-312
Number of pages6
JournalInternational Journal of Cardiology
Volume151
Issue number3
DOIs
StatePublished - Sep 15 2011
Externally publishedYes

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Eisenmenger Complex
Heart Diseases
Iron
Quality of Life
Exercise
Exercise Tolerance
Therapeutics
Transferrin
Ferritins
Hemoglobins
Safety

Keywords

  • Cyanotic congenital heart disease
  • Exercise capacity
  • Iron replacement therapy
  • Quality of life

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome. / Tay, Edgar L W; Peset, Ana; Papaphylactou, Maria; Inuzuka, Ryo; Alonso-Gonzalez, Rafael; Giannakoulas, Georgios; Tzifa, Aphrodite; Goletto, Sara; Broberg, Craig; Dimopoulos, Konstantinos; Gatzoulis, Michael A.

In: International Journal of Cardiology, Vol. 151, No. 3, 15.09.2011, p. 307-312.

Research output: Contribution to journalArticle

Tay, ELW, Peset, A, Papaphylactou, M, Inuzuka, R, Alonso-Gonzalez, R, Giannakoulas, G, Tzifa, A, Goletto, S, Broberg, C, Dimopoulos, K & Gatzoulis, MA 2011, 'Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome', International Journal of Cardiology, vol. 151, no. 3, pp. 307-312. https://doi.org/10.1016/j.ijcard.2010.05.066
Tay, Edgar L W ; Peset, Ana ; Papaphylactou, Maria ; Inuzuka, Ryo ; Alonso-Gonzalez, Rafael ; Giannakoulas, Georgios ; Tzifa, Aphrodite ; Goletto, Sara ; Broberg, Craig ; Dimopoulos, Konstantinos ; Gatzoulis, Michael A. / Replacement therapy for iron deficiency improves exercise capacity and quality of life in patients with cyanotic congenital heart disease and/or the Eisenmenger syndrome. In: International Journal of Cardiology. 2011 ; Vol. 151, No. 3. pp. 307-312.
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abstract = "Introduction: Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population. Methods: Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200 mg thrice-daily. The CAMPHOR QoL questionnaire, 6 minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3 months of treatment. Results: Mean age was 39.9 ± 10.9 years, 80{\%} females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3 months of treatment, hemoglobin (19.0 ± 2.9 g/dL to 20.4 ± 2.7 g/dL, p <0.001), ferritin (13.3 ± 4.7 μg/L to 54.1 ± 24.2 μg/L, p <0.001) and transferrin saturation (17.8 ± 9.6{\%} to 34.8 ± 23.4{\%}, p <0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7 ± 10.9 to 16.2 ± 10.4, p = 0.001) and 6MWT distance (371.7 ± 84.7 m to 402.8.0 ± 74.9 m, p = 0.001). Peak VO 2 remained unchanged (40.7 ± 9.2{\%} to 43.8 ± 12.4{\%} of predicted, p = 0.15). Conclusion: Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.",
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AU - Tay, Edgar L W

AU - Peset, Ana

AU - Papaphylactou, Maria

AU - Inuzuka, Ryo

AU - Alonso-Gonzalez, Rafael

AU - Giannakoulas, Georgios

AU - Tzifa, Aphrodite

AU - Goletto, Sara

AU - Broberg, Craig

AU - Dimopoulos, Konstantinos

AU - Gatzoulis, Michael A.

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N2 - Introduction: Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population. Methods: Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200 mg thrice-daily. The CAMPHOR QoL questionnaire, 6 minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3 months of treatment. Results: Mean age was 39.9 ± 10.9 years, 80% females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3 months of treatment, hemoglobin (19.0 ± 2.9 g/dL to 20.4 ± 2.7 g/dL, p <0.001), ferritin (13.3 ± 4.7 μg/L to 54.1 ± 24.2 μg/L, p <0.001) and transferrin saturation (17.8 ± 9.6% to 34.8 ± 23.4%, p <0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7 ± 10.9 to 16.2 ± 10.4, p = 0.001) and 6MWT distance (371.7 ± 84.7 m to 402.8.0 ± 74.9 m, p = 0.001). Peak VO 2 remained unchanged (40.7 ± 9.2% to 43.8 ± 12.4% of predicted, p = 0.15). Conclusion: Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.

AB - Introduction: Iron deficiency is common in cyanotic congenital heart disease (CHD) and results in reduced exercise tolerance. Currently, iron replacement is advocated with limited evidence in cyanotic CHD. We investigated the safety and efficacy of iron replacement therapy in this population. Methods: Twenty-five iron-deficient cyanotic CHD patients were prospectively studied between August 2008 and January 2009. Oral ferrous fumarate was titrated to a maximum dose of 200 mg thrice-daily. The CAMPHOR QoL questionnaire, 6 minute walk test (6MWT) and cardiopulmonary exercise testing were conducted at baseline and after 3 months of treatment. Results: Mean age was 39.9 ± 10.9 years, 80% females. Fourteen had Eisenmenger syndrome, 6 complex cyanotic disease and 5 Fontan circulation. There were no adverse effects necessitating termination of treatment. After 3 months of treatment, hemoglobin (19.0 ± 2.9 g/dL to 20.4 ± 2.7 g/dL, p <0.001), ferritin (13.3 ± 4.7 μg/L to 54.1 ± 24.2 μg/L, p <0.001) and transferrin saturation (17.8 ± 9.6% to 34.8 ± 23.4%, p <0.001) significantly increased. Significant improvements were also detected in the total CAMPHOR score (20.7 ± 10.9 to 16.2 ± 10.4, p = 0.001) and 6MWT distance (371.7 ± 84.7 m to 402.8.0 ± 74.9 m, p = 0.001). Peak VO 2 remained unchanged (40.7 ± 9.2% to 43.8 ± 12.4% of predicted, p = 0.15). Conclusion: Three months of iron replacement therapy in iron-deficient cyanotic CHD patients was safe and resulted in significant improvement in exercise tolerance and quality of life. Identification of iron deficiency and appropriate replacement should be advocated in these patients.

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KW - Exercise capacity

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KW - Quality of life

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