Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency
Iron repletion augments exercise capacity in chronic heart failure (HF), but there is a lack of mechanistic data explaining how iron could augment exercise performance despite minimal changes in hemoglobin (Hb). Besides Hb, iron is an obligate component of mitochondrial enzymes that generate cellula...
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| creator | Charles-Edwards, Geoffrey Amaral, Nelson Sleigh, Alison Ayis, Salma Catibog, Norman McDonagh, Theresa Monaghan, Mark Amin-Youssef, George Kemp, Graham J Shah, Ajay M Okonko, Darlington O |
| description | Iron repletion augments exercise capacity in chronic heart failure (HF), but there is a lack of mechanistic data explaining how iron could augment exercise performance despite minimal changes in hemoglobin (Hb). Besides Hb, iron is an obligate component of mitochondrial enzymes that generate cellular energy in the form of adenosine triphosphate and phosphocreatine (PCr). Dynamic phosphorus magnetic resonance spectroscopy is a noninvasive tool that quantifies in vivo muscle energetics by measuring the kinetics of PCr recovery after exertion. We tested the hypothesis that intravenous iron repletion in chronic HF enhances skeletal muscle energetics as reflected by shorter PCr recovery half-times (PCr t
) on phosphorus magnetic resonance spectroscopy.
We enrolled 40 patients (50% anemic) with chronic HF, New York Heart Association class ≥II, left ventricular ejection fraction ≤45%, and iron deficiency (ferritin |
| doi_str_mv | 10.1161/CIRCULATIONAHA.118.038516 |
| format | Article |
| fullrecord | <record><control><sourceid>pubmed</sourceid><recordid>TN_cdi_pubmed_primary_30776909</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>30776909</sourcerecordid><originalsourceid>FETCH-LOGICAL-c1636-fcf167bfb8ef26f5f0b7d1da14a96044384224a2bd1b091e3471c9e67149ba393</originalsourceid><addsrcrecordid>eNo1j99KwzAchYMgbk5fQeIDdCZNmjSXpe5PYTrRDS9Hkv7iol07muxib29henU4h48PDkKPlEwpFfSprN7L7arYVOvXYlkMWz4lLM-ouEJjmqU84RlTI3QbwjchRDCZ3aARI1IKRdQYxZlzYCPuHK76rsVV6A66iV3wNeChf_xAA1E3-OUUbAN41kL_BdHbgH2L33T00MaAP33c43I_GLzFS9B9xHPtm1MPWLf1Rf0MztsBt-c7dO10E-D-LydoO59tymWyWi-qslgllgomEmcdFdI4k4NLhcscMbKmtaZcK0E4ZzlPU65TU1NDFAXGJbUKhKRcGc0Um6CHi_d4Mgeod8feH3R_3v3fZ7-8514d</addsrcrecordid><sourcetype>Index Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency</title><source>MEDLINE</source><source>American Heart Association Journals</source><source>Journals@Ovid Complete</source><source>EZB-FREE-00999 freely available EZB journals</source><creator>Charles-Edwards, Geoffrey ; Amaral, Nelson ; Sleigh, Alison ; Ayis, Salma ; Catibog, Norman ; McDonagh, Theresa ; Monaghan, Mark ; Amin-Youssef, George ; Kemp, Graham J ; Shah, Ajay M ; Okonko, Darlington O</creator><creatorcontrib>Charles-Edwards, Geoffrey ; Amaral, Nelson ; Sleigh, Alison ; Ayis, Salma ; Catibog, Norman ; McDonagh, Theresa ; Monaghan, Mark ; Amin-Youssef, George ; Kemp, Graham J ; Shah, Ajay M ; Okonko, Darlington O</creatorcontrib><description>Iron repletion augments exercise capacity in chronic heart failure (HF), but there is a lack of mechanistic data explaining how iron could augment exercise performance despite minimal changes in hemoglobin (Hb). Besides Hb, iron is an obligate component of mitochondrial enzymes that generate cellular energy in the form of adenosine triphosphate and phosphocreatine (PCr). Dynamic phosphorus magnetic resonance spectroscopy is a noninvasive tool that quantifies in vivo muscle energetics by measuring the kinetics of PCr recovery after exertion. We tested the hypothesis that intravenous iron repletion in chronic HF enhances skeletal muscle energetics as reflected by shorter PCr recovery half-times (PCr t
) on phosphorus magnetic resonance spectroscopy.
We enrolled 40 patients (50% anemic) with chronic HF, New York Heart Association class ≥II, left ventricular ejection fraction ≤45%, and iron deficiency (ferritin<100 μg/L or 100-300 μg/L with transferrin saturation <20%). Subjects underwent stratified (anemic versus nonanemic) randomization (1:1) to a single, double-blinded, total dose infusion of iron isomaltoside or saline placebo with end points reassessed early at 2 weeks posttreatment to minimize confounding from exercise adaptation. The primary end point was PCr t
at 2 weeks. Secondary end points included ADP recovery half-time (ADP t
energetic marker), iron status, symptoms, Hb, exercise capacity, and safety.
In the total population, treatment groups were similar at baseline. At 2 weeks, iron isomaltoside improved PCr t
(adjusted difference, -6.8 s; 95% CI, 11.5 to -2.1; P=0.006), ADP t
(-5.3 s; 95% CI, -9.7 to -0.9; P=0.02), ferritin (304 ng/mL; 95% CI, 217-391; P<0.0001), transferrin saturation (6.8%; 95% CI, 2.7-10.8; P=0.002), New York Heart Association class (-0.23; 95% CI, -0.46 to -0.01; P=0.04), resting respiratory rate (-0.7 breaths/min; 95% CI, -1.2 to -0.2; P=0.009), and postexercise Borg dyspnea score (-2.0; 95% CI, -3.7 to -0.3; P=0.04), but not Hb (2.4 g/L; 95% CI, -3.5 to 8.4; P=0.41). Adverse events were similar between groups. In subgroup analyses, iron isomaltoside improved PCr t
in anemic (-8.4 s; 95% CI, -16.7 to -0.2; P=0.04) and nonanemic (-5.2 s; 95% CI, -10.6 to 0.2; P=0.06) cohorts.
In patients with chronic HF and iron deficiency, a total repletion dose of iron isomaltoside given at a single sitting is well tolerated and associated with faster skeletal muscle PCr t
at 2 weeks, implying better mitochondrial function. Augmented skeletal muscle energetics might therefore be an important mechanism via which iron repletion confers benefits in chronic HF despite minimal Hb changes.
URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-005592-13/GB . Unique identifier: EudraCT 2012-005592-13.</description><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.118.038516</identifier><identifier>PMID: 30776909</identifier><language>eng</language><publisher>United States</publisher><subject>Aged ; Aged, 80 and over ; Anemia, Iron-Deficiency - blood ; Anemia, Iron-Deficiency - diagnosis ; Anemia, Iron-Deficiency - drug therapy ; Biomarkers - blood ; Disaccharides - adverse effects ; Disaccharides - therapeutic use ; Double-Blind Method ; Energy Metabolism - drug effects ; Exercise Tolerance - drug effects ; Female ; Ferric Compounds - adverse effects ; Ferric Compounds - therapeutic use ; Heart Failure - diagnosis ; Heart Failure - drug therapy ; Heart Failure - physiopathology ; Hematinics - adverse effects ; Hematinics - therapeutic use ; Humans ; Iron - blood ; Iron - deficiency ; London ; Magnetic Resonance Spectroscopy ; Male ; Middle Aged ; Muscle, Skeletal - drug effects ; Muscle, Skeletal - metabolism ; Muscle, Skeletal - physiopathology ; Phosphocreatine - metabolism ; Recovery of Function ; Time Factors ; Treatment Outcome</subject><ispartof>Circulation (New York, N.Y.), 2019-05, Vol.139 (21), p.2386</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c1636-fcf167bfb8ef26f5f0b7d1da14a96044384224a2bd1b091e3471c9e67149ba393</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27915,27916</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30776909$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charles-Edwards, Geoffrey</creatorcontrib><creatorcontrib>Amaral, Nelson</creatorcontrib><creatorcontrib>Sleigh, Alison</creatorcontrib><creatorcontrib>Ayis, Salma</creatorcontrib><creatorcontrib>Catibog, Norman</creatorcontrib><creatorcontrib>McDonagh, Theresa</creatorcontrib><creatorcontrib>Monaghan, Mark</creatorcontrib><creatorcontrib>Amin-Youssef, George</creatorcontrib><creatorcontrib>Kemp, Graham J</creatorcontrib><creatorcontrib>Shah, Ajay M</creatorcontrib><creatorcontrib>Okonko, Darlington O</creatorcontrib><title>Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Iron repletion augments exercise capacity in chronic heart failure (HF), but there is a lack of mechanistic data explaining how iron could augment exercise performance despite minimal changes in hemoglobin (Hb). Besides Hb, iron is an obligate component of mitochondrial enzymes that generate cellular energy in the form of adenosine triphosphate and phosphocreatine (PCr). Dynamic phosphorus magnetic resonance spectroscopy is a noninvasive tool that quantifies in vivo muscle energetics by measuring the kinetics of PCr recovery after exertion. We tested the hypothesis that intravenous iron repletion in chronic HF enhances skeletal muscle energetics as reflected by shorter PCr recovery half-times (PCr t
) on phosphorus magnetic resonance spectroscopy.
We enrolled 40 patients (50% anemic) with chronic HF, New York Heart Association class ≥II, left ventricular ejection fraction ≤45%, and iron deficiency (ferritin<100 μg/L or 100-300 μg/L with transferrin saturation <20%). Subjects underwent stratified (anemic versus nonanemic) randomization (1:1) to a single, double-blinded, total dose infusion of iron isomaltoside or saline placebo with end points reassessed early at 2 weeks posttreatment to minimize confounding from exercise adaptation. The primary end point was PCr t
at 2 weeks. Secondary end points included ADP recovery half-time (ADP t
energetic marker), iron status, symptoms, Hb, exercise capacity, and safety.
In the total population, treatment groups were similar at baseline. At 2 weeks, iron isomaltoside improved PCr t
(adjusted difference, -6.8 s; 95% CI, 11.5 to -2.1; P=0.006), ADP t
(-5.3 s; 95% CI, -9.7 to -0.9; P=0.02), ferritin (304 ng/mL; 95% CI, 217-391; P<0.0001), transferrin saturation (6.8%; 95% CI, 2.7-10.8; P=0.002), New York Heart Association class (-0.23; 95% CI, -0.46 to -0.01; P=0.04), resting respiratory rate (-0.7 breaths/min; 95% CI, -1.2 to -0.2; P=0.009), and postexercise Borg dyspnea score (-2.0; 95% CI, -3.7 to -0.3; P=0.04), but not Hb (2.4 g/L; 95% CI, -3.5 to 8.4; P=0.41). Adverse events were similar between groups. In subgroup analyses, iron isomaltoside improved PCr t
in anemic (-8.4 s; 95% CI, -16.7 to -0.2; P=0.04) and nonanemic (-5.2 s; 95% CI, -10.6 to 0.2; P=0.06) cohorts.
In patients with chronic HF and iron deficiency, a total repletion dose of iron isomaltoside given at a single sitting is well tolerated and associated with faster skeletal muscle PCr t
at 2 weeks, implying better mitochondrial function. Augmented skeletal muscle energetics might therefore be an important mechanism via which iron repletion confers benefits in chronic HF despite minimal Hb changes.
URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-005592-13/GB . Unique identifier: EudraCT 2012-005592-13.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anemia, Iron-Deficiency - blood</subject><subject>Anemia, Iron-Deficiency - diagnosis</subject><subject>Anemia, Iron-Deficiency - drug therapy</subject><subject>Biomarkers - blood</subject><subject>Disaccharides - adverse effects</subject><subject>Disaccharides - therapeutic use</subject><subject>Double-Blind Method</subject><subject>Energy Metabolism - drug effects</subject><subject>Exercise Tolerance - drug effects</subject><subject>Female</subject><subject>Ferric Compounds - adverse effects</subject><subject>Ferric Compounds - therapeutic use</subject><subject>Heart Failure - diagnosis</subject><subject>Heart Failure - drug therapy</subject><subject>Heart Failure - physiopathology</subject><subject>Hematinics - adverse effects</subject><subject>Hematinics - therapeutic use</subject><subject>Humans</subject><subject>Iron - blood</subject><subject>Iron - deficiency</subject><subject>London</subject><subject>Magnetic Resonance Spectroscopy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Muscle, Skeletal - drug effects</subject><subject>Muscle, Skeletal - metabolism</subject><subject>Muscle, Skeletal - physiopathology</subject><subject>Phosphocreatine - metabolism</subject><subject>Recovery of Function</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo1j99KwzAchYMgbk5fQeIDdCZNmjSXpe5PYTrRDS9Hkv7iol07muxib29henU4h48PDkKPlEwpFfSprN7L7arYVOvXYlkMWz4lLM-ouEJjmqU84RlTI3QbwjchRDCZ3aARI1IKRdQYxZlzYCPuHK76rsVV6A66iV3wNeChf_xAA1E3-OUUbAN41kL_BdHbgH2L33T00MaAP33c43I_GLzFS9B9xHPtm1MPWLf1Rf0MztsBt-c7dO10E-D-LydoO59tymWyWi-qslgllgomEmcdFdI4k4NLhcscMbKmtaZcK0E4ZzlPU65TU1NDFAXGJbUKhKRcGc0Um6CHi_d4Mgeod8feH3R_3v3fZ7-8514d</recordid><startdate>20190521</startdate><enddate>20190521</enddate><creator>Charles-Edwards, Geoffrey</creator><creator>Amaral, Nelson</creator><creator>Sleigh, Alison</creator><creator>Ayis, Salma</creator><creator>Catibog, Norman</creator><creator>McDonagh, Theresa</creator><creator>Monaghan, Mark</creator><creator>Amin-Youssef, George</creator><creator>Kemp, Graham J</creator><creator>Shah, Ajay M</creator><creator>Okonko, Darlington O</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>20190521</creationdate><title>Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency</title><author>Charles-Edwards, Geoffrey ; Amaral, Nelson ; Sleigh, Alison ; Ayis, Salma ; Catibog, Norman ; McDonagh, Theresa ; Monaghan, Mark ; Amin-Youssef, George ; Kemp, Graham J ; Shah, Ajay M ; Okonko, Darlington O</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c1636-fcf167bfb8ef26f5f0b7d1da14a96044384224a2bd1b091e3471c9e67149ba393</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anemia, Iron-Deficiency - blood</topic><topic>Anemia, Iron-Deficiency - diagnosis</topic><topic>Anemia, Iron-Deficiency - drug therapy</topic><topic>Biomarkers - blood</topic><topic>Disaccharides - adverse effects</topic><topic>Disaccharides - therapeutic use</topic><topic>Double-Blind Method</topic><topic>Energy Metabolism - drug effects</topic><topic>Exercise Tolerance - drug effects</topic><topic>Female</topic><topic>Ferric Compounds - adverse effects</topic><topic>Ferric Compounds - therapeutic use</topic><topic>Heart Failure - diagnosis</topic><topic>Heart Failure - drug therapy</topic><topic>Heart Failure - physiopathology</topic><topic>Hematinics - adverse effects</topic><topic>Hematinics - therapeutic use</topic><topic>Humans</topic><topic>Iron - blood</topic><topic>Iron - deficiency</topic><topic>London</topic><topic>Magnetic Resonance Spectroscopy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Muscle, Skeletal - drug effects</topic><topic>Muscle, Skeletal - metabolism</topic><topic>Muscle, Skeletal - physiopathology</topic><topic>Phosphocreatine - metabolism</topic><topic>Recovery of Function</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charles-Edwards, Geoffrey</creatorcontrib><creatorcontrib>Amaral, Nelson</creatorcontrib><creatorcontrib>Sleigh, Alison</creatorcontrib><creatorcontrib>Ayis, Salma</creatorcontrib><creatorcontrib>Catibog, Norman</creatorcontrib><creatorcontrib>McDonagh, Theresa</creatorcontrib><creatorcontrib>Monaghan, Mark</creatorcontrib><creatorcontrib>Amin-Youssef, George</creatorcontrib><creatorcontrib>Kemp, Graham J</creatorcontrib><creatorcontrib>Shah, Ajay M</creatorcontrib><creatorcontrib>Okonko, Darlington O</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charles-Edwards, Geoffrey</au><au>Amaral, Nelson</au><au>Sleigh, Alison</au><au>Ayis, Salma</au><au>Catibog, Norman</au><au>McDonagh, Theresa</au><au>Monaghan, Mark</au><au>Amin-Youssef, George</au><au>Kemp, Graham J</au><au>Shah, Ajay M</au><au>Okonko, Darlington O</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2019-05-21</date><risdate>2019</risdate><volume>139</volume><issue>21</issue><spage>2386</spage><pages>2386-</pages><eissn>1524-4539</eissn><abstract>Iron repletion augments exercise capacity in chronic heart failure (HF), but there is a lack of mechanistic data explaining how iron could augment exercise performance despite minimal changes in hemoglobin (Hb). Besides Hb, iron is an obligate component of mitochondrial enzymes that generate cellular energy in the form of adenosine triphosphate and phosphocreatine (PCr). Dynamic phosphorus magnetic resonance spectroscopy is a noninvasive tool that quantifies in vivo muscle energetics by measuring the kinetics of PCr recovery after exertion. We tested the hypothesis that intravenous iron repletion in chronic HF enhances skeletal muscle energetics as reflected by shorter PCr recovery half-times (PCr t
) on phosphorus magnetic resonance spectroscopy.
We enrolled 40 patients (50% anemic) with chronic HF, New York Heart Association class ≥II, left ventricular ejection fraction ≤45%, and iron deficiency (ferritin<100 μg/L or 100-300 μg/L with transferrin saturation <20%). Subjects underwent stratified (anemic versus nonanemic) randomization (1:1) to a single, double-blinded, total dose infusion of iron isomaltoside or saline placebo with end points reassessed early at 2 weeks posttreatment to minimize confounding from exercise adaptation. The primary end point was PCr t
at 2 weeks. Secondary end points included ADP recovery half-time (ADP t
energetic marker), iron status, symptoms, Hb, exercise capacity, and safety.
In the total population, treatment groups were similar at baseline. At 2 weeks, iron isomaltoside improved PCr t
(adjusted difference, -6.8 s; 95% CI, 11.5 to -2.1; P=0.006), ADP t
(-5.3 s; 95% CI, -9.7 to -0.9; P=0.02), ferritin (304 ng/mL; 95% CI, 217-391; P<0.0001), transferrin saturation (6.8%; 95% CI, 2.7-10.8; P=0.002), New York Heart Association class (-0.23; 95% CI, -0.46 to -0.01; P=0.04), resting respiratory rate (-0.7 breaths/min; 95% CI, -1.2 to -0.2; P=0.009), and postexercise Borg dyspnea score (-2.0; 95% CI, -3.7 to -0.3; P=0.04), but not Hb (2.4 g/L; 95% CI, -3.5 to 8.4; P=0.41). Adverse events were similar between groups. In subgroup analyses, iron isomaltoside improved PCr t
in anemic (-8.4 s; 95% CI, -16.7 to -0.2; P=0.04) and nonanemic (-5.2 s; 95% CI, -10.6 to 0.2; P=0.06) cohorts.
In patients with chronic HF and iron deficiency, a total repletion dose of iron isomaltoside given at a single sitting is well tolerated and associated with faster skeletal muscle PCr t
at 2 weeks, implying better mitochondrial function. Augmented skeletal muscle energetics might therefore be an important mechanism via which iron repletion confers benefits in chronic HF despite minimal Hb changes.
URL: https://www.clinicaltrialsregister.eu/ctr-search/trial/2012-005592-13/GB . Unique identifier: EudraCT 2012-005592-13.</abstract><cop>United States</cop><pmid>30776909</pmid><doi>10.1161/CIRCULATIONAHA.118.038516</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | Circulation (New York, N.Y.), 2019-05, Vol.139 (21), p.2386 |
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| language | eng |
| recordid | cdi_pubmed_primary_30776909 |
| source | MEDLINE; American Heart Association Journals; Journals@Ovid Complete; EZB-FREE-00999 freely available EZB journals |
| subjects | Aged Aged, 80 and over Anemia, Iron-Deficiency - blood Anemia, Iron-Deficiency - diagnosis Anemia, Iron-Deficiency - drug therapy Biomarkers - blood Disaccharides - adverse effects Disaccharides - therapeutic use Double-Blind Method Energy Metabolism - drug effects Exercise Tolerance - drug effects Female Ferric Compounds - adverse effects Ferric Compounds - therapeutic use Heart Failure - diagnosis Heart Failure - drug therapy Heart Failure - physiopathology Hematinics - adverse effects Hematinics - therapeutic use Humans Iron - blood Iron - deficiency London Magnetic Resonance Spectroscopy Male Middle Aged Muscle, Skeletal - drug effects Muscle, Skeletal - metabolism Muscle, Skeletal - physiopathology Phosphocreatine - metabolism Recovery of Function Time Factors Treatment Outcome |
| title | Effect of Iron Isomaltoside on Skeletal Muscle Energetics in Patients With Chronic Heart Failure and Iron Deficiency |
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