Turk Kardiyol Dern Ars. 2022; 50(7): 492-497 | DOI: 10.5543/tkda.2022.22343

The Effects of Iron Replacement on Functional Capacity in Patients with Group 1 and Group 4 Pulmonary Hypertension

Dursun Akaslan¹, Emre Aslanger¹, Halil Ataş¹, Batur Gönenç Kanar¹, Derya Kocakaya², Bedrettin Yıldızeli³, Bülent Mutlu^1
1Department of Cardiology, Marmara University, Pendik Training and Research Hospital, İstanbul, Turkey
²Department of Pulmonology, Marmara University, Pendik Training and Research Hospital, İstanbul, Turkey
³Department of Thoracic Surgery, Marmara University, Pendik Training and Research Hospital, İstanbul, Turkey

OBJECTIVE
Abnormal iron handling complicates pulmonary hypertension and causes functional limitation and poor outcomes. Although preliminary results in group 1 pulmonary hypertension patients support the use of iron replacement, whether this applies to other PH subgroups is not known.


METHODS
A total of 58 patients with an established diagnosis of group 1 or 4 pulmonary hypertension, who had serum ferritin of <100 ng/mL or 100-300 ng/mL in combination with a transferrin saturation <20% and received 500-1000 mg of ferric carboxymaltose, were included in the study. The change in ferritin levels and transferrin saturation was calculated at 12- and 24-week follow-up. A six-minute walk test is undertaken at the first, 12-week, and 24-week follow-up visits.


RESULTS
In group 1 pulmonary hypertension patients, ferritin levels increased from 14 ng/mL to 133 and 90 ng/mL at 12- and 24-week, respectively (P <.001 for both). In group 4 pulmonary hypertension patients, ferritin levels increased from 22.1 ng/mL to 145 and 88.9 ng/mL at 12 and 24 weeks, respectively (P <.001 for both). The 6-minute walk test distances were 356, 412, and 350 m in group 1 pulmonary hypertension patients and 260, 315, and 290 m in group 4 pulmonary hypertension patients. Although the difference between baseline and 12-week 6-minute walk test was significant in both groups (P <.001 for both), this difference was lost at 24-week.


CONCLUSION
Our study indicates that there is no difference in response to iron replacement in patients with group 1 and group 4 pulmonary hypertension patients, in terms of treatment success and functional status.

Keywords: Anemia, chronic thromboembolic pulmonary hypertension, ferric carboxymaltose, pulmonary arterial hypertension, pulmonary hypertension

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