EFFECT OF COMBINED ORAL FERROTHERAPY WITH L-CARNITINE ON EXERCISE TOLERANCE OF PATIENTS WITH CHRONIC HEART FAILURE WITH REDUCED EJECTION FRACTION OF LEFT VENTRICLE WITH CONCOMITANT IRON DEFICIENCY ANEMIA

Valerii Ivanov, Маriia Kolesnyk

Abstract


According to numerous studies, a high prevalence of iron deficiency (ID) with anaemic syndrome and its association with mortality during chronic heart failure (CHF) have been revealed. Ferrocorrection of anaemia during CHF is important both to improve the clinical condition and to optimize the long-term prognosis of patients. However, the pathogenetic justification is the use of agents that have antihypoxic, antioxidant and membrane-stabilizing effects, except iron preparations, and at the same time exert a regulatory effect on the metabolism of physiologically active compounds and improve the functional condition of patients.

The aim. The aim of this study was to identify and compare the effect of oral ferrotherapy and combined use of ferrotherapy with L-carnitine on exercise tolerance (ET) of patients with CHF with reduced ejection fraction of left ventricle (LVEF) with concomitant iron deficiency anemia (IDA) was determined and compared.

Materials and methods. The study includes 62 patients with CHF with reduced LVEF FC II-III according to NYHA with IDА. Patients with hypertensive and ischemic etiology of HF took part in the study. Among them, 45 (72.6 %) were men and 17 (27.4 %) were women aged 70.0±0.9 years. Two study groups were formed: in addition to the standard therapy, the patients in the 1st group (n=32) were prescribed oral ferrous sulfate in a dose of 320 mg, equivalent to 100 mg of bivalent iron and 60 mg of ascorbic acid 2 tablets per day for 6 months; the patients in the 2nd group (n=30) received the standard therapy of CHF and not only iron, but also L-carnitine.

Results and discussion. The use of two variants of ferrocorrection as an application to the standard treatment of CHF among the total number of studied patients with IDA indicates the sufficient effect both to eliminate the signs of anemia and to eliminate ID. The analysis of the dynamics of the passed test distance with a 6-minute walk in 32 patients with IDA on the background of standard treatment and additional ferrotherapy after 6 months showed an increase of the actual distance by 8.9 % (from 249.4 to 272.3 m, p<0.0001). The analysis of changes in the value of travelled distance among patients with IDA who received combined 6-month ferrotherapy with L-carnitine also revealed a significant positive trend. In addition, the value obtained was significantly higher compared to the results of patients with only additional ferrotherapy, an increase of 19.4 % (from 259.5 to 304.5 m, p<0.0001).

Conclusions. The use of metabolic therapy with oral ferrotherapy is accompanied by a greater increase in ET, which is reflected in a significantly longer test distance with a 6-minute walk and greater frequency of decrease of FC of HF among patients, compared with using only iron sulfate ferrocorrection.


Keywords


chronic heart failure; iron deficiency anemia; indices of iron metabolism

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References


Voronkov, L. G. (2015) Anemiya u pacienta s HSN: kak ocenivat i kak lechit? Sertseva nedostatnist, 2, 5–15.

Mamas, M. A., Sperrin, M., Watson, M. C., Coutts, A., Wilde, K., Burton, C. et. al. (2017). Do patients have worse outcomes in heart failure than in cancer? A primary care-based cohort study with 10-year follow-up in Scotland. European Journal of Heart Failure, 19 (9), 1095–1104. doi: http://doi.org/10.1002/ejhf.822

Anand, I. S., Gupta, P. (2018). Anemia and Iron Deficiency in Heart Failure. Circulation, 138 (1), 80–98. doi: http://doi.org/10.1161/circulationaha.118.030099

Goodnough, L. T., Schrier, S. L. (2014). Evaluation and management of anemia in the elderly. American Journal of Hematology, 89 (1), 88–96. doi: http://doi.org/10.1002/ajh.23598

Ivanov, V. P., Kolesnyk, M. O., Kolesnyk, O. M., Ivanova, Y. I. (2018). Anemia from the perspective of the problem of chronic heart failure: pathogenesis and laboratory diagnosis. Acta Medica Leopoliensia, 24 (2), 69–76. doi: http://doi.org/10.25040/aml2018.02.069

Stuklov, N. I. (2017). Iron deficiency and anemia in patients with chronic heart failure. Rational Pharmacotherapy in Cardiology, 13 (5), 651–660. doi: http://doi.org/10.20996/1819-6446-2017-13-5-651-660

Weiss, G. (2009). Iron metabolism in the anemia of chronic disease. Biochimica et Biophysica Acta (BBA) – General Subjects, 1790 (7), 682–693. doi: http://doi.org/10.1016/j.bbagen.2008.08.006

Anand, I. S. (2008). Anemia and Chronic Heart Failure. Journal of the American College of Cardiology, 52 (7), 501–511. doi: http://doi.org/10.1016/j.jacc.2008.04.044

Ivanov, V. P., Kolesnyk, M. O. (2019). Сomparative characteristics of quality of life indicators in patients with chronic heart failure with reduced left ventricular ejection fraction depending on iron deficiency type. Eastern Ukrainian Medical Journal, 7 (3), 246–256. doi: http://doi.org/10.21272/eumj.2019;7(3):246-256

Tang, Y.-D., Katz, S. D. (2008). The prevalence of anemia in chronic heart failure and its impact on the clinical outcomes. Heart Failure Reviews, 13 (4), 387–392. doi: http://doi.org/10.1007/s10741-008-9089-7

Duygu, K., Kadri, M. G. (2016). Iron deficiency and its treatment in heart failure: indications and effect on prognosis. E-Journal of Cardiology Practice, 14 (30). Available at: https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Iron-deficiency-and-its-treatment-in-heart-failure-indications-and-effect-on-prognosis

Comín-Colet, J., Enjuanes, C., González, G., Torrens, A., Cladellas, M., Meroño, O. et. al. (2013). Iron deficiency is a key determinant of health-related quality of life in patients with chronic heart failure regardless of anaemia status. European Journal of Heart Failure, 15 (10), 1164–1172. doi: http://doi.org/10.1093/eurjhf/hft083

Song, X., Qu, H., Yang, Z., Rong, J., Cai, W., Zhou, H. (2017). Efficacy and Safety of L-Carnitine Treatment for Chronic Heart Failure: A Meta-Analysis of Randomized Controlled Trials. BioMed Research International, 2017, 1–11. doi: http://doi.org/10.1155/2017/6274854

Anon Acetyl-L-carnitine (2010). Altern Med Rev, 15 (1), 76–83.

Ferrari, R., Merli, E., Cicchitelli, G., Mele, D., Fucili, A., Ceconi, C. (2004). Therapeutic Effects of l-Carnitine and Propionyl-l-carnitine on Cardiovascular Diseases: A Review. Annals of the New York Academy of Sciences, 1033 (1), 79–91. doi: http://doi.org/10.1196/annals.1320.007

Marcovina, S. M., Sirtori, C., Peracino, A., Gheorghiade, M., Borum, P., Remuzzi, G., Ardehali, H. (2013). Translating the basic knowledge of mitochondrial functions to metabolic therapy: role of L-carnitine. Translational Research, 161 (2), 73–84. doi: http://doi.org/10.1016/j.trsl.2012.10.006

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H. et. al. (2013). ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American college of cardiology foundation. American Heart Association task force on practice guidelines. Circulation, 128 (16), 1810–1852. doi: http://doi.org/10.1161/cir.0b013e31829e8807

Mant, J., Al-Mohammad, A., Swain, S., Laramée, P. (2011). Management of Chronic Heart Failure in Adults: Synopsis of the National Institute for Health and Clinical Excellence Guideline. Annals of Internal Medicine, 155 (4), 252–259. doi: http://doi.org/10.7326/0003-4819-155-4-201108160-00009

Špinar, J., Hradec, J., Špinarová, L., Vítovec, J. (2016). Summary of the 2016 ESC Guidelines on the diagnosis and treatment of acute and chronic heart failure. Prepared by the Czech Society of Cardiology. Cor et Vasa, 58 (5), e530–e568. doi: http://doi.org/10.1016/j.crvasa.2016.09.004

Andreozzi, G. M., Leone, A., Laudani, R., Martin, R., Deinit, G., Cataldi, V. (2008). Levo-Propionyl-Carnitine Improves the Effectiveness of Supervised Physical Training on the Absolute Claudication Distance in Patients With Intermittent Claudication. Angiology, 59 (1), 84–89. doi: http://doi.org/10.1177/0003319707304567




DOI: http://dx.doi.org/10.21303/2504-5679.2019.001085

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