{"id":"f4edebd0f4ba","type":"article","url":"https://hartvaat.nl/2021/12/21/iv-ijzercarboxymaltose-en-cardiale-reverse-remodellering-na-crt-iron-crt/","title":"IV ijzercarboxymaltose en cardiale reverse remodellering na CRT: IRON-CRT","title_en":"The effect of intravenous ferric carboxymaltose on cardiac reverse remodelling following cardiac resynchronization therapy-the IRON-CRT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["ijzersuppletie","ijzertekort"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehab411","source_url":"https://doi.org/10.1093/eurheartj/ehab411","authors":["Pieter Martens","Matthias Dupont","Jeroen Dauw","Petra Nijst","Lieven Herbots","Paul Dendale","Pieter Vandervoort","Liesbeth Bruckers","Wai Hong Wilson Tang","Wilfried Mullens"],"significance":7,"published":"2021-12-21","source_date":"2021-12-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/cardiale-remodellering/"],"congress":"","summary_en":"The IRON-CRT trial demonstrated that intravenous ferric carboxymaltose enhances cardiac reverse remodeling after CRT implantation in iron-deficient heart failure patients, suggesting that iron repletion and resynchronization have synergistic cardiac benefits.","created":"2026-07-03T10:29:34Z","updated":"2026-07-03T13:28:41Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IRON-CRT trial naar het effect van IV ijzer op cardiale reverse remodellering na CRT.","abstract_original":"AIMS: Iron deficiency is common in heart failure with reduced ejection fraction (HFrEF) and negatively affects cardiac function and structure. The study the effect of ferric carboxymaltose (FCM) on cardiac reverse remodelling and contractile status in HFrEF. METHODS AND RESULTS: Symptomatic HFrEF patients with iron deficiency and a persistently reduced left ventricular ejection fraction (LVEF <45%) at least 6 months after cardiac resynchronization therapy (CRT) implant were prospectively randomized to FCM or standard of care (SOC) in a double-blind manner. The primary endpoint was the change in LVEF from baseline to 3-month follow-up assessed by three-dimensional echocardiography. Secondary endpoints included the change in left ventricular end-systolic (LVESV) and end-diastolic volume (LVEDV) from baseline to 3-month follow-up. Cardiac performance was evaluated by the force-frequency relationship as assessed by the slope change of the cardiac contractility index (CCI = systolic blood pressure/LVESV index) at 70, 90, and 110 beats of biventricular pacing. A total of 75 patients were randomized to FCM (n = 37) or SOC (n = 38). At baseline, both treatment groups were well matched including baseline LVEF (34 ± 7 vs. 33 ± 8, P = 0.411). After 3 months, the change in LVEF was significantly higher in the FMC group [+4.22%, 95% confidence interval (CI) +3.05%; +5.38%] than in the SOC group (-0.23%, 95% CI -1.44%; +0.97%; P < 0.001). Similarly, LVESV (-9.72 mL, 95% CI -13.5 mL; -5.93 mL vs. -1.83 mL, 95% CI -5.7 mL; 2.1 mL; P = 0.001), but not LVEDV (P = 0.748), improved in the FCM vs. the SOC group. At baseline, both treatment groups demonstrated a negative force-frequency relationship, as defined by a decrease in CCI at higher heart rates (negative slope). FCM resulted in an improvement in the CCI slope during incremental biventricular pacing, with a positive force-frequency relationship at 3 months. Functional status and exercise capacity, as measured by the Kansas City Cardiomyopathy Questionnaire and peak oxygen consumption, were improved by FCM. CONCLUSIONS: Treatment with FCM in HFrEF patients with iron deficiency and persistently reduced LVEF after CRT results in an improvement of cardiac function measured by LVEF, LVESV, and cardiac force-frequency relationship."}