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HOW ARE CARDIAC FUNCTIONS ALTERED IN PEDIATRIC PATIENTS RECEIVING ORAL IRON SUPPLEMENTATION DUE TO ANEMIA?

Year 2021, Volume: 5 Issue: 1, 81 - 92, 15.02.2021
https://doi.org/10.26900/jsp.5.1.07

Abstract

Objective: This study aims to investigate whether oral iron supplementation improves structural and functional alterations by evaluating the echocardiography and electrocardiography findings of the pediatric patients with iron deficiency anemia.Methods: This is a prospective review of 30 pediatric patients who were diagnosed with iron deficiency anemia and received 12-week-long iron supplementation at the study center. All children underwent hematological workup, detailed echocardiography examination and electrocardiography evaluation at the time of diagnosis for iron deficiency anemia andthe end of 12-week-long iron treatment.Results: After 12-week-long iron treatment, hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell count, Mentzer index, serum iron, serum iron binding capacity, serum ferritin and transferrin increased significantly (p=0.001, p=0.001, p=0.001, p=0.036, p=0.001, p=0.002, p=0.001 and p=0.001 respectively). Pulse rate, respiration rate, and diastolic left ventricle wall thickness decreased significantly while tricuspid E and A wave velocities increased significantly at the end of iron supplementation (p=0.004, p=0.033, p=0.009, p=0.003 and p=0.021 respectively). As for the tissue Doppler echocardiography findings, only interventricular septum isovolumetric contraction time decreased significantly after iron treatment (p=0.002). The PR interval shortened significantly, p dispersion decreased significantly and T-peak to T-end interval shortened significantly following iron supplementation (respectively p=0.013, p=0.033 and p=0.029).Conclusion: Oral iron supplementation seems to contribute to the reversal of cardiac remodeling, elimination of compensatory hemodynamic mechanisms and inhibition of sympathetic activation within cardiac tissues

References

  • ALIOGLU, B., CETIN, I.I., EMEKSIZ, Z.S., DINDAR, N., TAPCI, E. & DALLAR, Y. (2013). Iron deficiency anemia in infants: Does it really affect the myocardial functions? Pediatric Hematology and Oncology, 30(3), 239–245.
  • ANAND, I. S., GUPTA, P. (2018). Anemia and iron deficiency in heart failure. Circulation, 138(1), 80–98.
  • ANKER, S.D., COMIN COLET, J., FILIPPATOS, G., WILLENHEIMER, R., DICKSTEIN, K., DREXLER, H., LÜSCHER, T.F., BART, B., BANASIAK, W., NIEGOWSKA, J., KIRWAN, B.A., MORI, C., VON EISENHART ROTHE, B., POCOCK, S.J., POOLE-WILSON, P.A., PONIKOWSKI, P. (2009). Ferric carboxymaltose in patients with heart failure and iron deficiency. New England Journal of Medicine, 361(25), 2436–2448.
  • AVNI, T., LEIBOVICI, L., GAFTER-GVILI, A. (2012). Iron supplementation for the treatment of chronic heart failure and iron deficiency: systematic review and meta-analysis. European Journal of Heart Failure, 14(4), 423–429.
  • BAZETT, H.C. (1920). The time relations of the blood-pressure changes after excision of the adrenal glands, with some observations on blood volume changes. The Journal of Physiology, 53(5), 320–339.
  • CAMASCHELLA, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832–1843.
  • COHEN-SOLAL, A., DAMY, T., TERBAH, M., KEREBEL, S., BAGUET, J.P., HANON, O., ZANNAD, F., LAPERCHE, T., LECLERCQ, C., CONCAS, V., DUVILLIÉ, L., DARNÉ, B., ANKER, S., MEBAZAA, A. (2014). High prevalence of iron deficiency in patients with acute decompensated heart failure. European Journal of Heart Failure, 16(9), 984–991.
  • DELOUGHERY, T.G. (2017). Iron deficiency anemia. Medical Clinics of North America, 101(2), 319–332.
  • DINSHAW, L., MÜNCH, J., DICKOW, J., LEZIUS, S., WILLEMS, S., HOFFMANN, B.A., PATTEN, M. (2018). The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy. Clinical Research in Cardiology, 107(2), 130–137.
  • HEGDE, N., RICH, M.W., GAYOMALI, C. (2006). The cardiomyopathy of iron deficiency. Texas Heart Institute Journal, 33(3), 340–344.
  • JANKOWSKA, E.A., PONIKOWSKI, P. (2010). Molecular Changes in myocardium in the course of anemia or iron deficiency. Heart Failure Clinics, 6(3), 295–304.
  • KOBAK, K.A., RADWAŃSKA, M., DZIĘGAŁA, M., KASZTURA, M., JOSIAK, K., BANASIAK, W., PONIKOWSKI, P., JANKOWSKA, E.A. (2019). Structural and functional abnormalities in iron-depleted heart. Heart Failure Reviews, 24(2), 269–277.
  • LOPEZ, A., CACOUB, P., MACDOUGALL, I.C., PEYRIN-BIROULET, L. (2016). Iron deficiency anaemia. The Lancet, 387(10021), 907–916.
  • MCLEAN, E., COGSWELL, M., EGLI, I., WOJDYLA, D., DE BENOIST, B. (2009). Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutrition, 12(4), 444–454.
  • NAGUEH, S.F., SMISETH, O.A., APPLETON, C.P., BYRD, B.F., DOKAINISH, H., EDVARDSEN, T., FLACHSKAMPF, F.A., GILLEBERT, T.C., KLEIN, A.L., LANCELLOTTI, P., MARINO, P., OH, J.K., POPESCU, B.A., WAGGONER, A.D. (2016). Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 29(4), 277–314.
  • OKUTUCU, S., AYTEMIR, K., OTO, A. (2016). P-wave dispersion: What we know till now? JRSM Cardiovascular Disease, 5, 204800401663944.
  • PÉREZ-RIERA, A.R., DE ABREU, L.C., BARBOSA-BARROS, R., GRINDLER, J., FERNANDES-CARDOSO, A., BARANCHUK, A. (2016). P-wave dispersion: an update. Indian Pacing and Electrophysiology Journal, 16(4), 126–133.
  • PONIKOWSKI, P., VAN VELDHUISEN, D.J., COMIN-COLET, J., ERTL, G., KOMAJDA, M., MAREEV, V., MCDONAGH, T., PARKHOMENKO, A., TAVAZZI, L., LEVESQUE, V., MORI, C., ROUBERT, B., FILIPPATOS, G., RUSCHITZKA, F., ANKER, S.D. (2015). Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. European Heart Journal, 36(11), 657–668.
  • POWERS, J.M., BUCHANAN, G.R. (2014). Diagnosis and management of iron deficiency anemia. Hematology/Oncology Clinics of North America, 28(4), 729–745.
  • SCHUMACHER, K., DAGRES, N., HINDRICKS, G., HUSSER, D., BOLLMANN, A., KORNEJ, J. (2017). Characteristics of PR interval as predictor for atrial fibrillation: association with biomarkers and outcomes. Clinical Research in Cardiology, 106(10), 767–775.
  • SIMSEK, H., GUNES, Y., DEMIR, C., SAHIN, M., GUMRUKCUOGLU, H.A., TUNCER, M. (2010). The effects of iron deficiency anemia on p wave duration and dispersion. Clinics, 65(11), 1067–1071.
  • SUBRAMANIAM, G., GIRISH, M. (2015). Iron deficiency anemia in children. The Indian Journal of Pediatrics, 82(6), 558–564.
  • TSE, G., GONG, M., MENG, L., WONG, C.W., BAZOUKIS, G., CHAN, M.T.V., WONG, M.C.S., LETSAS, K.P., BARANCHUK, A., YAN, G.X., LIU, T., WU, W. K. K. (2018). Predictive value of Tpeak – tend indices for adverse outcomes in acquired QT prolongation: A meta-analysis. Frontiers in Physiology, 9, 1226.
  • TURNER, L.R., PREMO, D.A., GIBBS, B.J., HEARTHWAY, M.L., MOTSKO, M., SAPPINGTON, A., WALKER, L., MULLENDORE, M.E., CHEW, H. G. (2002). Adaptations to iron deficiency: Cardiac functional responsiveness to norepinephrine, arterial remodeling, and the effect of beta-blockade on cardiac hypertrophy. BMC Physiology, 2(1), 1.
  • VAN VELDHUISEN, D.J., PONIKOWSKI, P., VAN DER MEER, P., METRA, M., BÖHM, M., DOLETSKY, A., VOORS, A.A., MACDOUGALL, I.C., ANKER, S.D., ROUBERT, B., ZAKIN, L., COHEN-SOLAL, A. (2017). Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency. Circulation, 136(15), 1374–1383.
  • WANG, M. (2016). Iron deficiency and other types of anemia in infants and children. American Family Physician, 93(4), 270–278.
  • YOKUSOGLU, M., NEVRUZ, O., BAYSAN, O., UZUN, M., DEMIRKOL, S., AVCU, F., KOZ, C., ÇETIN, T., HASIMI, A., URAL, A.U., ISIK, E. (2007). The altered autonomic nervous system activity in iron deficiency anemia. The Tohoku Journal of Experimental Medicine, 212(4), 397–402.
Year 2021, Volume: 5 Issue: 1, 81 - 92, 15.02.2021
https://doi.org/10.26900/jsp.5.1.07

Abstract

References

  • ALIOGLU, B., CETIN, I.I., EMEKSIZ, Z.S., DINDAR, N., TAPCI, E. & DALLAR, Y. (2013). Iron deficiency anemia in infants: Does it really affect the myocardial functions? Pediatric Hematology and Oncology, 30(3), 239–245.
  • ANAND, I. S., GUPTA, P. (2018). Anemia and iron deficiency in heart failure. Circulation, 138(1), 80–98.
  • ANKER, S.D., COMIN COLET, J., FILIPPATOS, G., WILLENHEIMER, R., DICKSTEIN, K., DREXLER, H., LÜSCHER, T.F., BART, B., BANASIAK, W., NIEGOWSKA, J., KIRWAN, B.A., MORI, C., VON EISENHART ROTHE, B., POCOCK, S.J., POOLE-WILSON, P.A., PONIKOWSKI, P. (2009). Ferric carboxymaltose in patients with heart failure and iron deficiency. New England Journal of Medicine, 361(25), 2436–2448.
  • AVNI, T., LEIBOVICI, L., GAFTER-GVILI, A. (2012). Iron supplementation for the treatment of chronic heart failure and iron deficiency: systematic review and meta-analysis. European Journal of Heart Failure, 14(4), 423–429.
  • BAZETT, H.C. (1920). The time relations of the blood-pressure changes after excision of the adrenal glands, with some observations on blood volume changes. The Journal of Physiology, 53(5), 320–339.
  • CAMASCHELLA, C. (2015). Iron-deficiency anemia. New England Journal of Medicine, 372(19), 1832–1843.
  • COHEN-SOLAL, A., DAMY, T., TERBAH, M., KEREBEL, S., BAGUET, J.P., HANON, O., ZANNAD, F., LAPERCHE, T., LECLERCQ, C., CONCAS, V., DUVILLIÉ, L., DARNÉ, B., ANKER, S., MEBAZAA, A. (2014). High prevalence of iron deficiency in patients with acute decompensated heart failure. European Journal of Heart Failure, 16(9), 984–991.
  • DELOUGHERY, T.G. (2017). Iron deficiency anemia. Medical Clinics of North America, 101(2), 319–332.
  • DINSHAW, L., MÜNCH, J., DICKOW, J., LEZIUS, S., WILLEMS, S., HOFFMANN, B.A., PATTEN, M. (2018). The T-peak-to-T-end interval: a novel ECG marker for ventricular arrhythmia and appropriate ICD therapy in patients with hypertrophic cardiomyopathy. Clinical Research in Cardiology, 107(2), 130–137.
  • HEGDE, N., RICH, M.W., GAYOMALI, C. (2006). The cardiomyopathy of iron deficiency. Texas Heart Institute Journal, 33(3), 340–344.
  • JANKOWSKA, E.A., PONIKOWSKI, P. (2010). Molecular Changes in myocardium in the course of anemia or iron deficiency. Heart Failure Clinics, 6(3), 295–304.
  • KOBAK, K.A., RADWAŃSKA, M., DZIĘGAŁA, M., KASZTURA, M., JOSIAK, K., BANASIAK, W., PONIKOWSKI, P., JANKOWSKA, E.A. (2019). Structural and functional abnormalities in iron-depleted heart. Heart Failure Reviews, 24(2), 269–277.
  • LOPEZ, A., CACOUB, P., MACDOUGALL, I.C., PEYRIN-BIROULET, L. (2016). Iron deficiency anaemia. The Lancet, 387(10021), 907–916.
  • MCLEAN, E., COGSWELL, M., EGLI, I., WOJDYLA, D., DE BENOIST, B. (2009). Worldwide prevalence of anaemia, WHO Vitamin and Mineral Nutrition Information System, 1993–2005. Public Health Nutrition, 12(4), 444–454.
  • NAGUEH, S.F., SMISETH, O.A., APPLETON, C.P., BYRD, B.F., DOKAINISH, H., EDVARDSEN, T., FLACHSKAMPF, F.A., GILLEBERT, T.C., KLEIN, A.L., LANCELLOTTI, P., MARINO, P., OH, J.K., POPESCU, B.A., WAGGONER, A.D. (2016). Recommendations for the evaluation of left ventricular diastolic function by echocardiography: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Journal of the American Society of Echocardiography, 29(4), 277–314.
  • OKUTUCU, S., AYTEMIR, K., OTO, A. (2016). P-wave dispersion: What we know till now? JRSM Cardiovascular Disease, 5, 204800401663944.
  • PÉREZ-RIERA, A.R., DE ABREU, L.C., BARBOSA-BARROS, R., GRINDLER, J., FERNANDES-CARDOSO, A., BARANCHUK, A. (2016). P-wave dispersion: an update. Indian Pacing and Electrophysiology Journal, 16(4), 126–133.
  • PONIKOWSKI, P., VAN VELDHUISEN, D.J., COMIN-COLET, J., ERTL, G., KOMAJDA, M., MAREEV, V., MCDONAGH, T., PARKHOMENKO, A., TAVAZZI, L., LEVESQUE, V., MORI, C., ROUBERT, B., FILIPPATOS, G., RUSCHITZKA, F., ANKER, S.D. (2015). Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency. European Heart Journal, 36(11), 657–668.
  • POWERS, J.M., BUCHANAN, G.R. (2014). Diagnosis and management of iron deficiency anemia. Hematology/Oncology Clinics of North America, 28(4), 729–745.
  • SCHUMACHER, K., DAGRES, N., HINDRICKS, G., HUSSER, D., BOLLMANN, A., KORNEJ, J. (2017). Characteristics of PR interval as predictor for atrial fibrillation: association with biomarkers and outcomes. Clinical Research in Cardiology, 106(10), 767–775.
  • SIMSEK, H., GUNES, Y., DEMIR, C., SAHIN, M., GUMRUKCUOGLU, H.A., TUNCER, M. (2010). The effects of iron deficiency anemia on p wave duration and dispersion. Clinics, 65(11), 1067–1071.
  • SUBRAMANIAM, G., GIRISH, M. (2015). Iron deficiency anemia in children. The Indian Journal of Pediatrics, 82(6), 558–564.
  • TSE, G., GONG, M., MENG, L., WONG, C.W., BAZOUKIS, G., CHAN, M.T.V., WONG, M.C.S., LETSAS, K.P., BARANCHUK, A., YAN, G.X., LIU, T., WU, W. K. K. (2018). Predictive value of Tpeak – tend indices for adverse outcomes in acquired QT prolongation: A meta-analysis. Frontiers in Physiology, 9, 1226.
  • TURNER, L.R., PREMO, D.A., GIBBS, B.J., HEARTHWAY, M.L., MOTSKO, M., SAPPINGTON, A., WALKER, L., MULLENDORE, M.E., CHEW, H. G. (2002). Adaptations to iron deficiency: Cardiac functional responsiveness to norepinephrine, arterial remodeling, and the effect of beta-blockade on cardiac hypertrophy. BMC Physiology, 2(1), 1.
  • VAN VELDHUISEN, D.J., PONIKOWSKI, P., VAN DER MEER, P., METRA, M., BÖHM, M., DOLETSKY, A., VOORS, A.A., MACDOUGALL, I.C., ANKER, S.D., ROUBERT, B., ZAKIN, L., COHEN-SOLAL, A. (2017). Effect of ferric carboxymaltose on exercise capacity in patients with chronic heart failure and iron deficiency. Circulation, 136(15), 1374–1383.
  • WANG, M. (2016). Iron deficiency and other types of anemia in infants and children. American Family Physician, 93(4), 270–278.
  • YOKUSOGLU, M., NEVRUZ, O., BAYSAN, O., UZUN, M., DEMIRKOL, S., AVCU, F., KOZ, C., ÇETIN, T., HASIMI, A., URAL, A.U., ISIK, E. (2007). The altered autonomic nervous system activity in iron deficiency anemia. The Tohoku Journal of Experimental Medicine, 212(4), 397–402.
There are 27 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Health Sciences
Authors

Merve Hiçyılmaz This is me 0000-0002-1797-0543

Ayhan Pektas 0000-0002-3238-0752

Selçuk Gürel 0000-0001-5300-9795

Mehmet Bilgehan Pektaş 0000-0003-0055-7688

Publication Date February 15, 2021
Published in Issue Year 2021 Volume: 5 Issue: 1

Cite

APA Hiçyılmaz, M., Pektas, A., Gürel, S., Pektaş, M. B. (2021). HOW ARE CARDIAC FUNCTIONS ALTERED IN PEDIATRIC PATIENTS RECEIVING ORAL IRON SUPPLEMENTATION DUE TO ANEMIA?. Journal of Scientific Perspectives, 5(1), 81-92. https://doi.org/10.26900/jsp.5.1.07