Short‐Term Changes in Left and Right Ventricular Cardiac Magnetic Resonance Feature Tracking Strain Following Ferric Carboxymaltose in Patients With Heart Failure: A Substudy of the Myocardial‐IRON Trial
Authors: del Canto Irene , Santas Enrique , Cardells Ingrid , Miñana Gema , Palau Patricia , Llàcer Pau , Fácila Lorenzo , López‐Vilella Raquel , Almenar Luis , Bodí Vicent , López‐Lereu Maria P. , Monmeneu Jose V. , Sanchis Juan , Moratal David , Maceira Alicia M. , de la Espriella Rafael , Chorro Francisco J. , Bayés‐Genís Antoni , Núñez Julio , Núñez Julio , Santas Enrique , Miñana Gema , Palau Patricia , Amiguet Martina , González Jessika , Valero Ernesto , García‐Blas Sergio , Bodí Vicent , de la Espriella‐Juan Rafael , Navarro Jorge , Sanchis Juan , Chorro Francisco J , Soler Meritxell , Villaescusa Amparo , Civera Jose , Mollar Anna , Serrano Alicia , Llácer Pau , Moreno Maria del Carmen , Cardells Ingrid , Fácila Lorenzo , Montagud Vicente , Vidal Veronica , Almenar Luis , López‐Vilella Raquel 
Published: March 2022

Background
The mechanisms explaining the clinical benefits of ferric carboximaltose (FCM) in patients with heart failure, reduced or intermediate left ventricular ejection fraction, and iron deficiency remain not fully clarified. The Myocardial‐IRON trial showed short‐term cardiac magnetic resonance (CMR) changes suggesting myocardial iron repletion following administration of FCM but failed to find a significant increase in left ventricular ejection fraction in the whole sample. Conversely, the strain assessment could evaluate more specifically subtle changes in contractility. In this subanalysis, we aimed to evaluate the effect of FCM on the short‐term left and right ventricular CMR feature tracking derived strain.

Methods and Results

This is a post hoc subanalysis of the double‐blind, placebo‐controlled, randomized clinical trial that enrolled 53 ambulatory patients with heart failure and left ventricular ejection fraction <50%, and iron deficiency [Myocardial‐IRON trial (NCT03398681)]. Three‐dimensional left and 2‐dimensional right ventricular CMR tracking strain (longitudinal, circumferential, and radial) changes were evaluated before, 7 and 30 days after randomization using linear mixed‐effect analysis. The median (interquartile range) age of the sample was 73 years (65–78), and 40 (75.5%) were men. At baseline, there were no significant differences in CMR feature tracking strain parameters across both treatment arms. At 7 days, the only global 3‐dimensional left ventricular circumferential strain was significantly higher in the FCM treatment‐arm (difference: −1.6%,
P
=0.001). At 30 days, and compared with placebo, global 3‐dimensional left ventricular strain parameters significantly improved in those allocated to FCM treatment‐arm [longitudinal (difference: −2.3%,
P
<0.001), circumferential (difference: −2.5%,
P
<0.001), and radial (difference: 4.2%,
P
=0.002)]. Likewise, significant improvements in global right ventricular strain parameters were found in the active arm at 30 days (longitudinal [difference: −3.3%,
P
=0.010], circumferential [difference: −4.5%,
P
<0.001], and radial [difference: 4.5%,
P
=0.027]).

Conclusions
In patients with stable heart failure, left ventricular ejection fraction <50%, and iron deficiency, treatment with FCM was associated with short‐term improvements in left and right ventricular function assessed by CMR feature tracking derived strain parameters.

Registration

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT03398681.