The Impact of Intravenous Ferric Carboxymaltose on Reverse Electrical Remodeling Following Cardiac Resynchronization Therapy

Abstract

Background: The influence of intravenous ferric carboxymaltose (FCM) on reverse electrical remodeling (RER) in patients with heart failure with reduced ejection fraction (HFrEF) post-cardiac resynchronization therapy (CRT) is unknown. This study examines the effect of iron replacement using intravenous FCM on RER in CRT-implanted HFrEF patients with iron deficiency anemia.

Methods: We retrospectively analyzed 65 patients with successful CRT-defibrillator between March 2017 and January 2020, all with iron deficiency anemia at implantation. The cohort comprised 35 patients in the FCM group and 30 in the non-FCM group. Follow-up data were obtained from visits 6 months post-CRT implantation including baseline characteristics, echocardiographic left ventricular measurements, and electrocardiograms. Changes in intrinsic QRS duration (iQRS) and left ventricular ejection fraction (LVEF) from baseline to 6 months were assessed.

Results: The FCM group showed a greater reduction in iQRS duration compared to the non-FCM group (-10.4 ± 2.2 ms vs. -3 ± 2.9 ms, p < 0.0001). Additionally, at the 6-month follow-up, the increase in LVEF was higher in the FCM group than in the non-FCM group (+3.6 ± 1.6% vs. -0.1 ± 1.7%, p < 0.0001). Correlations were found between changes in ferritin levels and iQRS duration (r = -0.725, p < 0.0001) and LVEF (r = 0.712, p < 0.0001). Multivariate regression analysis revealed that elevated ferritin independently influenced the increase in LVEF (p = 0.006, β = 0.554) and the decrease in iQRS (p < 0.001, β = -0.685).

Conclusions: Intravenous iron treatment with FCM may reduce iQRS duration and improve LVEF and functional status in HFrEF patients with iron deficiency anemia following CRT.

Keywords: Cardiac resynchronization therapy; Heart failure; Iron deficiency; Reverse electrical remodeling.

Figure 1

Change in primary and secondary endpoints. The changes in intrinsic QRS duration (delta QRS duration) (A), left ventricular ejection fraction (B), left ventricular end-diastolic diameter (C), left-ventricular end-systolic diameter (D), left ventricular end-diastolic volume (E), and left ventricular end-systolic volume (F) at 6-month follow-up of the CRT implantation. FCM, ferric carboxymaltose; LVDD, left ventricular end-diastolic diameter; LVEDV, left ventricular end-diastolic volume; LVEF, left ventricular ejection fraction; LVESD, left-ventricular end-systolic diameter; LVESV, left ventricular end-systolic volume.