Effect of intravenous ferric carboxymaltose on oxidative stress markers in patients with heart failure and iron deficiency
E R T Yencilek, C Tunca, Y Oz, M,F Dursun, A Tas, H A Kurklu, O K Ferik, S Neselioglu, V O TanikAbstract
Background
Iron deficiency is a common comorbidity in patients with heart failure with reduced ejection fraction (HFrEF) and contributes to impaired mitochondrial function, reduced oxygen utilisation, increased oxidative stress, and adverse clinical outcomes. While intravenous ferric carboxymaltose (FCM) has been shown to improve symptoms, exercise capacity, and hospitalisation rates, its effects on oxidative stress and redox balance remain incompletely defined.
Purpose
This study aimed to investigate the effects of intravenous ferric carboxymaltose therapy on oxidative stress biomarkers particularly ischaemia-modified albumin (IMA) and thiol-disulphide homeostasis in patients with HFrEF and iron deficiency.
Methods
In this prospective study, 50 clinically stable HFrEF patients (LVEF ≤40%) with iron deficiency received intravenous ferric carboxymaltose. Serum iron parameters, haemoglobin, ischaemia-modified albumin (IMA), and thiol–disulphide homeostasis indices (native thiol, total thiol, disulphide, and related ratios) were assessed at baseline and four weeks after treatment. Changes between pre- and post-treatment values were analysed using paired statistical tests.
Results
Following therapy, significant improvements in iron parameters were observed, including increases in ferritin, serum iron, transferrin saturation, and haemoglobin levels (all p<0.001), along with a marked reduction in total iron-binding capacity (p<0.001), confirming effective iron repletion. Importantly, IMA levels decreased significantly after treatment (0.80±0.11 vs. 0.76±0.11, p=0.002), suggesting a reduction in oxidative stress and ischaemia-related protein modification. In contrast, native thiol, total thiol, disulphide levels, and thiol–disulphide ratios did not show significant changes over the short-term follow-up period (all p>0.05).
Conclusion
In patients with HFrEF and iron deficiency, intravenous ferric carboxymaltose therapy is associated not only with effective restoration of iron stores but also with a significant reduction in ischaemia-modified albumin, indicating an improvement in oxidative stress status. These findings suggest that the benefits of FCM may extend beyond haematological correction to include favourable redox modulation. However, the lack of change in thiol–disulphide homeostasis implies that certain antioxidant pathways may require longer-term exposure or follow-up to demonstrate measurable effects. Further prospective studies are needed to elucidate the long-term clinical and mechanistic implications of these observations.Baseline characteristics,laboratory dataFor image description, please refer to the figure legend and surrounding text.