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Background <p>The mechanisms underlying the clinical benefit of intravenous iron in patients with heart failure (HF), left ventricular ejection fraction (LVEF) &lt; 50%, and iron deficiency (ID) remain incompletely defined. Clinical evidence suggests that iron repletion may improve ventricular synchrony and augment the response to cardiac resynchronization therapy (CRT). The longitudinal systolic dyssynchrony index (L-SDI), derived from cardiac magnetic resonance feature tracking (CMR-FT), provides a non-invasive measure of mechanical dyssynchrony. This subanalysis of the Myocardial-IRON trial evaluated the short-term effects of ferric carboxymaltose (FCM) on L-SDI and explored its relationship with global left ventricular longitudinal strain (GLS).</p> Methods <p>In this post hoc analysis of the randomized, double-blind, placebo-controlled Myocardial-IRON trial (NCT03398681), 51 of 53 ambulatory patients (96.2%) with stable HF, LVEF &lt; 50%, and ID underwent CMR-FT at baseline, and at 7-day, and 30-days post-FCM. Linear mixed-effects models assessed the effect of FCM versus placebo on L-SDI, including subgroup analyses by baseline QRS duration, and evaluated associations between changes in L-SDI and changes in GLS, T2*, and T1-mapping.</p> Results <p>Data are presented as mean ± SD or median (IQR), as appropriate. The participants have a mean age of 70.4 ± 9.6 years, with a median CMR-derived LVEF of 38.5% (IQR 33–45); the mean global longitudinal strain is −7.5 ± 3.6%. FCM leads to a greater reduction in L-SDI over time versus placebo (omnibus <i>p</i> = 0.015), with significance at 30 days (Δ=–3.8; 95% CI –6.9 to –0.7; <i>p</i> = 0.011). The benefit is most pronounced in patients with baseline electrical dyssynchrony (interaction <i>p</i> &lt; 0.001). Improvements in L-SDI are strongly associated with GLS gains (<i>p</i> &lt; 0.001) and myocardial iron uptake [T2*changes (<i>p</i> = 0.045) and T1-mapping changes (<i>p</i> = 0.011)].</p> Conclusions <p>In HF with LVEF &lt; 50% and ID, FCM improves short-term LV mechanical synchrony, particularly in those with electrical dyssynchrony, and this is linked to enhanced systolic function and greater myocardial iron repletion.</p> <p></p>

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Role of dyssynchrony in short-term left ventricular systolic function after iron repletion in patients with heart failure

  • 期刊论文

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  • 发表日期：

    2026年5月14日

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  • Irene del Canto,
  • Gema Miñana,
  • Ingrid Cardells,
  • Raquel López,
  • Luis Almenar,
  • Pau Llácer,
  • Maria Pilar López-Lereu,
  • José Vicente Monmeneu,
  • Vicent Bodí,
  • Juan Sanchis,
  • Alicia Maceira,
  • Carlos G. Santos-Gallego,
  • Pieter Martens,
  • Julio Núñez,
  • Julio Núñez,
  • Enrique Santas,
  • Gema Miñana,
  • Patricia Palau,
  • Jessika González,
  • Ernesto Valero,
  • Sergio García-Blas,
  • Vicent Bodi,
  • Rafael de la Espriella-Juan,
  • Jorge Navarro,
  • Juan Sanchis,
  • Francisco J. Chorro,
  • Meritxell Soler,
  • Amparo Villaescusa,
  • Jose Civera,
  • Anna Mollar,
  • Martina Amiguet,
  • Pau Llácer,
  • Maria del Carmen Moreno,
  • Ingrid Cardells,
  • Raquel López-Vilella,
  • Alicia Serrano,
  • Alicia Maceira,
  • Maria Pilar López-Lereu,
  • Jose Vicente Monmeneu,
  • Lorenzo Fácila,
  • Vicente Montagud,
  • Veronica Vida,
  • Antoni Bayés-Genís,
  • Josep Lupón

摘要

Background

The mechanisms underlying the clinical benefit of intravenous iron in patients with heart failure (HF), left ventricular ejection fraction (LVEF) < 50%, and iron deficiency (ID) remain incompletely defined. Clinical evidence suggests that iron repletion may improve ventricular synchrony and augment the response to cardiac resynchronization therapy (CRT). The longitudinal systolic dyssynchrony index (L-SDI), derived from cardiac magnetic resonance feature tracking (CMR-FT), provides a non-invasive measure of mechanical dyssynchrony. This subanalysis of the Myocardial-IRON trial evaluated the short-term effects of ferric carboxymaltose (FCM) on L-SDI and explored its relationship with global left ventricular longitudinal strain (GLS).

Methods

In this post hoc analysis of the randomized, double-blind, placebo-controlled Myocardial-IRON trial (NCT03398681), 51 of 53 ambulatory patients (96.2%) with stable HF, LVEF < 50%, and ID underwent CMR-FT at baseline, and at 7-day, and 30-days post-FCM. Linear mixed-effects models assessed the effect of FCM versus placebo on L-SDI, including subgroup analyses by baseline QRS duration, and evaluated associations between changes in L-SDI and changes in GLS, T2*, and T1-mapping.

Results

Data are presented as mean ± SD or median (IQR), as appropriate. The participants have a mean age of 70.4 ± 9.6 years, with a median CMR-derived LVEF of 38.5% (IQR 33–45); the mean global longitudinal strain is −7.5 ± 3.6%. FCM leads to a greater reduction in L-SDI over time versus placebo (omnibus p = 0.015), with significance at 30 days (Δ=–3.8; 95% CI –6.9 to –0.7; p = 0.011). The benefit is most pronounced in patients with baseline electrical dyssynchrony (interaction p < 0.001). Improvements in L-SDI are strongly associated with GLS gains (p < 0.001) and myocardial iron uptake [T2*changes (p = 0.045) and T1-mapping changes (p = 0.011)].

Conclusions

In HF with LVEF < 50% and ID, FCM improves short-term LV mechanical synchrony, particularly in those with electrical dyssynchrony, and this is linked to enhanced systolic function and greater myocardial iron repletion.