Positive effect of intravenous iron-oxide administration on left ventricular remodelling in patients with acute ST-elevation myocardial infarction - A cardiovascular magnetic resonance (CMR) study

INTERNATIONAL JOURNAL OF CARDIOLOGY

卷:173

Article

Florian, Anca¹  Ludwig, Anna²  Roesch, Sabine²  Yildiz, Handan²  Klumpp, Siegfried³  Sechtem, Udo²  Yilmaz, Ali¹ 

[1] Univ Hosp Munster, Dept Cardiol & Angiol, D-48149 Munster, Germany

[2] Robert Bosch Krankenhaus, Div Cardiol, Stuttgart, Germany

[3] Robert Bosch Krankenhaus, Stuttgart, Germany

关键词: USPIO;    Ferumoxytol;    CMR;    Myocardial infarction;    LGE;    Ventricular remodelling;   

DOI  :  10.1016/j.ijcard.2014.02.016

来源: Elsevier

【 摘 要 】

Objectives: This study investigated the safety profile and potentialtherapeutic effect of intravenous ultrasmall superparamagnetic iron-oxide (USPIO)-based iron administration regarding infarct healing in patients with ST-elevation myocardial infarction (STEMI). USPIO-administration was recently shown to enable an improved characterization of myocardial infarct pathology in acute STEMI patients. Materials and Methods: Seventeen study patients (IRON, 54 +/- 9 yrs, 88% male) and 22 matched controls (CONTROL, 57 +/- 9 yrs, 77% male) both with primary reperfused STEMI underwent multi-parametric CMR studies in the first week and three months after acute MI. Only IRON patients received a single intravenous bolus of 510 mg elemental iron as ferumoxytol (Feraheme(TM)) within four days following acute MI. Results: Threemonths later, all patientswere alive and therewere no adverse cardiac events. Significant improvement in left ventricular (LV) ejection fraction (IRON: 53 +/- 10% to 59 +/- 9%, p= 0.002; CONTROL: 54 +/- 6% to 57 +/- 10%, p = 0.005) as well as shrinkage of infarct size were seen in both groups at follow-up. There was a more pronounced decrease in infarct size in the IRON group (IRON: -10.3 +/- 5.4% vs. CONTROL: -7.0 +/- 8.4%, p = 0.050) in addition to a significant decrease in both endocardial extent and prevalence of transmural infarctions in IRON but not in CONTROL patients. A significant decrease in LV end systolic volumewas only seen in the IRON group (71 +/- 25 mL to 59 +/- 25 mL, p = 0.002). Conclusions: Intravenous iron administration in acute STEMI patients seems to be associated with an improved infarct healing and a beneficial global left ventricular remodelling. These findings together with the good safety profile make USPIO-based iron administration a promising future candidate as a diagnostic and therapeutic adjunctive solution in acute MI management. (c) 2014 Elsevier Ireland Ltd. All rights reserved.