avkАрхивъ внутренней медициныThe Russian Archives of Internal Medicine2226-67042411-6564“SINAPS” LLC10.20514/2226-6704-2025-15-2-85-101avk-1955Research ArticleОБЗОРНЫЕ СТАТЬИREVIEW ARTICLESПрименение препаратов железа у пациентов с легочной гипертензией: быстрый систематический обзорIron Use in Patients with Pulmonary Hypertension: A Rapid Systematic Reviewhttps://orcid.org/0009-0000-3615-2143БалькинаК. В.BalkinaK. V.

Балькина Ксения Васильевна — врач — кардиолог ГБУЗ Самарский областной клинический кардиологический диспансер им. В.П. Полякова; аспирант кафедры пропедевтической терапии с курсом кардиологии ГБОУ ВО Самарский государственный медицинский университет Минздрава России

Самара

Ksenia V. Bal’kina — cardiologist, State Budgetary Healthcare Institution Samara Regional Clinical Cardiology Dispensary named after V.P. Polyakov; Graduate Student of the Departm ent of Propaedeutic Therapy with a Course in Cardiology, Samara State Medical University, Ministry of Healthcare of the Russian Federation

Samara

kseniabal@list.ruhttps://orcid.org/0000-0003-3301-1577ПавловаТ. В.PavlovaT. V.

Павлова Татьяна Валентиновна — д.м.н., зав. отделением клинических исследований ГБУЗ Самарский областной клинический кардиологический диспансер им. В.П. Полякова; профессор кафедры пропедевтической терапии с курсом кар диологии ГБОУ ВО Самарский государственный медицинский университет Минздрава России

Самара

Tatyana V. Pavlova — MD, PhD, Head of the Clinical Research Department, Samara Regional Clinical Cardiology Dispensary named after V.P. Polyakov; Professor of the Department of Propaedeutic Therapy with a Course in Cardiology, Samara State Medical University, Ministry of Healthcare of the Russian Federation

Samara

ptvsam63@mail.ruhttps://orcid.org/0000-0002-6453-2976ДупляковД. В.DuplyakovD. V.

Дупляков Дмитрий Викторович — д.м.н., профессор, заведующий кафедрой пропедевтической терапии с курсом кардиологии ФГБОУ ВО «Самарский государственный медицинский университет» Министерства здравоохранения Российской Федерации; заместитель главного врача по медицинской части ГБУЗ «Самарский областной клинический кардиологический диспансер им. В.П. Полякова»

Самара

Dmitry V. Duplyakov — MD, PhD, Professor, Head of the Department of Propaedeutic Therapy with a Course in Cardiology, Samara State Medical University of the Ministry of Health of the Russian Federation; Deputy Chief Physician for Medical Affairs, Samara Regional Clinical Cardiology Dispensary named after V.P. Polyakov

Samara

duplyakov@yahoo.comГБУЗ Самарский областной клинический кардиологический диспансер им. В.П. ПоляковаРоссияV.P. Polyakov Samara Regional Clinical Cardiology DispensaryRussian FederationГБУЗ Самарский областной клинический кардиологический диспансер им. В.П. Полякова; ГБОУ ВО Самарский государственный медицинский университет Минздрава РоссииРоссияV.P. Polyakov Samara Regional Clinical Cardiology Dispensary; Samara State Medical UniversityRussian Federation20252503202515285101Copyright © Балькина К.В., Павлова Т.В., Дупляков Д.В., 20252025Балькина К.В., Павлова Т.В., Дупляков Д.В.Balkina K.V., Pavlova T.V., Duplyakov D.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.medarhive.ru/jour/article/view/1955

Дефицит железа широко распространён у пациентов с сердечно-сосудистыми заболевания ми. В последние годы активно изучается коррекция дефицита железа у пациентов с хронической сердечной недостаточностью для улучшения прогноза и течения заболевания. В настоящее время работ, посвящённых изучению применения препаратов железа у пациентов с лёгочной гипертензией, не так много. Целью нашего обзора явилось изучение возможности использования парентеральных препаратов железа у пациентов с лёгочной артериальной гипертензией для улучшения симптоматики и прогноза. В окончательный анализ вошли 5 публикаций. По результатам представленных исследований после применения препаратов железа у всех пациентов нормализовались лабораторные данные, характеризующие дефицит железа, повысилась толерантность к физической нагрузке, улучшилось качество жизни. При этом по показателям инструментальных исследований параметры были без динамики, катетеризация правых отделов сердца также показала отсутствие влияния на гемодинамические критерии. Во всех исследованиях препараты железа хорошо переносились, серьезных побочных явлений выявлено не было, что подтверждает возможность широкого применения лекарственных средств данной группы. Своевременная диагностика и лечение анемии и скрытого железодефицита у пациентов с легочной гипертензией профилактируют прогрессирование заболевания. Однако в настоящее время в реальной клинической практике парентеральные препараты железа у пациентов со скрытым его дефицитом используются редко, вследствие чего необходима активная разъяснительная работа среди практикующих врачей с целью расширения использования данного вида лечения.

Iron deficiency is widespread in patients with cardiovascular disease. In recent years, the correction of iron deficiency in patients with chronic heart failure has been actively studied to improve the prognosis and course of the disease. Currently, there are not many studies on the use of iron preparations in patients with pulmonary hypertension. The aim of our review was to explore the possibility of using parenteral iron preparations in patients with pulmonary arterial hypertension to improve symptoms and prognosis. The final analysis included 5 publications. According to the results of the presented studies, after the use of iron preparations, laboratory data characterizing iron deficiency were normalized in all patients, exercise tolerance increased, and the quality of life improved. At the same time, according to the indicators of instrumental studies, the parameters were without dynamics, catheterization of the right heart also showed no effect on hemodynamic criteria. In all studies, iron preparations were well tolerated, no serious side effects were detected, which confirms the possibility of widespread use of drugs of this group. Timely diagnosis and treatment of anemia and latent iron deficiency in patients with pulmonary hypertension prevent disease progression. However, at present, in real clinical practice, parenteral iron preparations are rarely used in patients with latent iron deficiency, as a result of which active outreach among practitioners is necessary in order to expand the use of this type of treatment.

легочная артериальная гипертензияжелезодефицитанемиякарбоксиматозат железаpulmonary arterial hypertensioniron defciencyanaemiaFerric carboxymaltoseReferencesHumbert M., Kovacs G., Hoeper M.M, et al. ESC/ERS Scientific Document Group. 4360 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation ( ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG). Eur Heart J. 2022; 43(38): 3618–3731. http://dx.doi.org/10.1093/eurheartj/ehac237Humbert M., Kovacs G., Hoeper M.M, et al. ESC/ERS Scientific Document Group. 4360 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension Developed by the task force for the diagnosis and treatment of pulmonary hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Endorsed by the International Society for Heart and Lung Transplantation ( ISHLT) and the European Reference Network on rare respiratory diseases (ERN-LUNG). Eur Heart J. 2022; 43(38): 3618–3731. http://dx.doi.org/10.1093/eurheartj/ehac237Simonneau G., Montani D., Celermajer D.S., et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019; 53:1801913. https://doi.org/10.1183/13993003.01913-2018Simonneau G., Montani D., Celermajer D.S., et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019; 53:1801913. https://doi.org/10.1183/13993003.01913-2018Чазова И.Е., Мартынюк Т.В., Шмальц А.А., и др. Евразийские рекомендации по диагностике и лечению легочной гипертензии (2023). 2024;(1):6-85. DOI: 10.38109/2225-1685-2024-1-6-85 (in Russian).Chazova I.E., Martynyuk T.V., Shmalts A.A., et al. Eurasian recommendations for the diagnosis and trea tment of pulmonary hypertension (2023). 2024;(1):6-85. DOI: 10.38109/2225-1685-2024-1-6-85 (in Russian).Hoeper M.M., Humbert M., Souza R. et al. A global view of pulmonary hypertension. Lancet Respir Med. 2016;4(4):306-22. doi: 10.1016/S2213-2600(15)00543-3.Hoeper M.M., Humbert M., Souza R. et al. A global view of pulmonary hypertension. Lancet Respir Med. 2016;4(4):306-22. doi: 10.1016/S2213-2600(15)00543-3.Anker S.D., Comin Colet J., Filippatos G. et al.; FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436-48. doi: 10.1056/NEJMoa0908355.Anker S.D., Comin Colet J., Filippatos G. et al.; FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency. N Engl J Med. 2009;361(25):2436-48. doi: 10.1056/NEJMoa0908355.van Veldhuisen, D.J., Ponikowski, P., van der Meer, P.et al. Effect of Ferric Carboxymaltose on Exercise Capacity in Patients with Chronic Heart Failure and Iron Deficiency. Circulation, 2017,136, 1374-1383. doi: 10.1161/CIRCULATIONAHA.117.027van Veldhuisen, D.J., Ponikowski, P., van der Meer, P.et al. Effect of Ferric Carboxymaltose on Exercise Capacity in Patients with Chronic Heart Failure and Iron Deficiency. Circulation, 2017,136, 1374-1383. doi: 10.1161/CIRCULATIONAHA.117.027Sonnweber T., Nairz M., Theurl I. et al. The crucial impact of iron deficiency definition for the course of precapillary pulmonary hypertension. PLoS ONE, 2018, 13(8): e0203396. doi: 10.1371/journal.pone.0203396Sonnweber T., Nairz M., Theurl I. et al. The crucial impact of iron deficiency definition for the course of precapillary pulmonary hypertension. PLoS ONE, 2018, 13(8): e0203396. doi: 10.1371/journal.pone.0203396Rhodes C.J., Howard L.S., Busbridge M. et al. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension: clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol. 2011;58(3):300-9. doi: 10.1016/j.jacc.2011.02.057.Rhodes C.J., Howard L.S., Busbridge M. et al. Iron deficiency and raised hepcidin in idiopathic pulmonary arterial hypertension: clinical prevalence, outcomes, and mechanistic insights. J Am Coll Cardiol. 2011;58(3):300-9. doi: 10.1016/j.jacc.2011.02.057.Rhodes C.J., Wharton J., Ghataorhe P. et al. Plasma proteome analysis in patients with pulmonary arterial hypertension: an observational cohort study. Lancet Respir Med. 2017;5(9):717-726. doi: 10.1016/S2213-2600(17)30161-3.Rhodes C.J., Wharton J., Ghataorhe P. et al. Plasma proteome analysis in patients with pulmonary arterial hypertension: an observational cohort study. Lancet Respir Med. 2017;5(9):717-726. doi: 10.1016/S2213-2600(17)30161-3.Van Empel V.P., Lee J., Williams T.J., et al. Iron deficiency in patients with idiopathic pulmonary arterial hypertension. Heart Lung Circ. 2014;23(3):287-92. doi: 10.1016/j.hlc.2013.08.007.Van Empel V.P., Lee J., Williams T.J., et al. Iron deficiency in patients with idiopathic pulmonary arterial hypertension. Heart Lung Circ. 2014;23(3):287-92. doi: 10.1016/j.hlc.2013.08.007.Willie C.K., Patrician A., Hoiland R.L., et al. Influence of iron manipulation on hypoxic pulmonary vasoconstriction and pulmonary reactivity during ascent and acclimatization to 5050 m. J Physiol. 2021;599(5):1685-1708. doi: 10.1113/JP281114.Willie C.K., Patrician A., Hoiland R.L., et al. Influence of iron manipulation on hypoxic pulmonary vasoconstriction and pulmonary reactivity during ascent and acclimatization to 5050 m. J Physiol. 2021;599(5):1685-1708. doi: 10.1113/JP281114.Smith T.G., Balanos G.M., Croft Q.P. et al. The increase in pulmonary arterial pressure caused by hypoxia depends on iron status. J Physiol. 2008;586(24):5999-6005. doi: 10.1113/jphysiol.2008.160960.Smith T.G., Balanos G.M., Croft Q.P. et al. The increase in pulmonary arterial pressure caused by hypoxia depends on iron status. J Physiol. 2008;586(24):5999-6005. doi: 10.1113/jphysiol.2008.160960.Cotroneo E., Ashek A., Wang L. et al. Iron homeostasis and pulmonary hypertension: iron deficiency leads to pulmonary vascular remodeling in the rat. Circ Res. (2015) 116:1680–90. 10.1161/CIRCRESAHA.116.305265Cotroneo E., Ashek A., Wang L. et al. Iron homeostasis and pulmonary hypertension: iron deficiency leads to pulmonary vascular remodeling in the rat. Circ Res. (2015) 116:1680–90. 10.1161/CIRCRESAHA.116.305265Lakhal-Littleton S., Crosby A., Frise M.C., et al. Intracellular iron deficiency in pulmonary arterial smooth muscle cells induces pulmonary arterial hypertension in mice. Proc Natl Acad Sci USA 2019; 116: 13122–13130. doi: 10.1073/pnas.1822010116.Lakhal-Littleton S., Crosby A., Frise M.C., et al. Intracellular iron deficiency in pulmonary arterial smooth muscle cells induces pulmonary arterial hypertension in mice. Proc Natl Acad Sci USA 2019; 116: 13122–13130. doi: 10.1073/pnas.1822010116.Soon E., Treacy C.M., Toshner M.R., et al. Unexplained iron deficiency in idiopathic and heritable pulmonary arterial hypertension. Thorax 2011; 66: 326–332. DOI: 10.1136/thx.2010.147272Soon E., Treacy C.M., Toshner M.R., et al. Unexplained iron deficiency in idiopathic and heritable pulmonary arterial hypertension. Thorax 2011; 66: 326–332. DOI: 10.1136/thx.2010.147272Rhodes C.J., Wharton J., Howard L., et al. Iron deficiency in pulmonary arterial hypertension: a potential therapeutic target. Eur Respir J. 2011;38(6):1453-60. doi: 10.1183/09031936.00037711.Rhodes C.J., Wharton J., Howard L., et al. Iron deficiency in pulmonary arterial hypertension: a potential therapeutic target. Eur Respir J. 2011;38(6):1453-60. doi: 10.1183/09031936.00037711.Viethen T., Gerhardt F., Dumitrescu D., et al. Ferric carboxymaltose improves exercise capacity and quality of life in patients with pulmonary arterial hypertension and iron deficiency: a pilot study. Int J Cardiol. (2014) 175:233–9. doi: 10.1016/j.ijcard.2014.04.233.Viethen T., Gerhardt F., Dumitrescu D., et al. Ferric carboxymaltose improves exercise capacity and quality of life in patients with pulmonary arterial hypertension and iron deficiency: a pilot study. Int J Cardiol. (2014) 175:233–9. doi: 10.1016/j.ijcard.2014.04.233.Ruiter G., Manders E., Happé C.M., et al. Intravenous iron therapy in patients with idiopathic pulmonary arterial hypertension and iron deficiency. Pulm Circ.2015; 5:466–72. 10.1086/682217Ruiter G., Manders E., Happé C.M., et al. Intravenous iron therapy in patients with idiopathic pulmonary arterial hypertension and iron deficiency. Pulm Circ.2015; 5:466–72. 10.1086/682217Blanche C., Alonso-Gonzalez R., Uribarri A., et al. Use of intravenous iron in cyanotic patients with congenital heart disease and/or pulmonary hypertension. Int J Cardiol . 2018; 267: 79-83. doi: 10.1016/j.ijcard.2018.05.062.Blanche C., Alonso-Gonzalez R., Uribarri A., et al. Use of intravenous iron in cyanotic patients with congenital heart disease and/or pulmonary hypertension. Int J Cardiol . 2018; 267: 79-83. doi: 10.1016/j.ijcard.2018.05.062.Howard LSGE, He Jianguo, Geoffrey M.J. et al. Supplementation with Iron in Pulmonary Arterial Hypertension. Two Randomized Crossover Trials Ann Am Thorac Soc. 2021; 18(6): 981–988. doi: 10.1513/AnnalsATS.202009-1131OCHoward LSGE, He Jianguo, Geoffrey M.J. et al. Supplementation with Iron in Pulmonary Arterial Hypertension. Two Randomized Crossover Trials Ann Am Thorac Soc. 2021; 18(6): 981–988. doi: 10.1513/AnnalsATS.202009-1131OCKramer T., Wissmüller M., Natsina K.et al. Ferric carboxymaltose in patients with pulmonary arterial hypertension and iron deficiency: a long-term study, Journal of Cachexia, Sarcopenia and Muscle, 2021, 12, 1501–1512, 10.1002/jcsm.12764.Kramer T., Wissmüller M., Natsina K.et al. Ferric carboxymaltose in patients with pulmonary arterial hypertension and iron deficiency: a long-term study, Journal of Cachexia, Sarcopenia and Muscle, 2021, 12, 1501–1512, 10.1002/jcsm.12764.Терещенко С.Н. Галявич А.С., Ускач Т.М. и др. Хроническая сердечная недостаточность. Клинические рекомендации 2020. Рос. кардиол. журн. 2020;25(11):311-74. DOI: 10.15829/1560-4071-2020-4083 (in Russian).Tereshchenko S.N. Galyavich A.S., Uskach T.M. et al. Chronic heart failure. Clinical recommendations 2020. Russian cardiol. J 2020; 25(11):311-74. DOI: 10.15829/1560-4071-2020-4083 (in Russian).Ponikowski P., Kirwan B.A., Anker S.D., et al. Ferric carboxymaltosePonikowski P., Kirwan B.A., Anker S.D., et al. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, con- trolled trial. Lancet (London, England). 2020;396(10266):1895–904. DOI: 10.1016/S0140-6736(20)32339-4for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, con- trolled trial. Lancet (London, England). 2020;396(10266):1895–904. DOI: 10.1016/S0140-6736(20)32339-4Mareev Yu.V., Gilyarevsky S.R., Begrambekova Yu.L. et al. The agreed opinion of experts on the treatment of iron deficiency in stable and de compensated patients with chronic heart failure. Cardiology 2021; 61(4): 73–8. DOI: 10.18087/cardio.2021.4.n1639 [in Russian].Мареев Ю.В., Гиляревский С.Р., Беграмбекова Ю.Л. и др. Согласованное мнение экспертов по поводу лечения дефицита железа у стабильных и декомпенсированных больных хронической сердечной недостаточностью. Кардиология. 2021;61(4):73–8. 10.18087/cardio.2021.4.n1639Zhilenkova Yu.I., Zolotova E.A., Vasilyeva E.Yu. et al. Study of iron me tabolism in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension Clin. Lab. diagnostics. 2024; 69(6): 30-43. [in Russian]. DOI: 10.17816/cld629834Жиленкова Ю.И., Золотова Е.А., Васильева Е.Ю. и др. Исследование обмена железа у пациентов с легочной артериальной гипертензией и хронической тромбоэмболической легочной гипертензией Клин. лаб. диагностика. 2024; 69(6): 30-43. DOI: 10.17816/cld629834Avdeev S.N., Barbarash O.L., Valieva Z.S. et al. 2024 Clinical practice guidelines for Pulmonary hypertension, including chronic thromboembolic pulmonary hypertension. Russian Journal of Cardiology. 2024; 29(11): 6161. [in Russian]. doi: 10.15829/1560-4071-2024-6161. EDN MYEOVAАвдеев С.Н., Барбараш О.Л., Валиева З.С. и др. Легочная гипертензия, в том числе хроническая тромбоэмболическая легочная гипертензия. Клинические рекомендации 2024. Российский кардиологический журнал. 2024; 29(11): 6161. doi: 10.15829/1560-4071-2024-6161. EDN MYEOVABroberg C.S., Jayaweera A.R., Diller G.P. et al. Seeking the Optimal Relation between Oxygen Saturation and Hemoglobin Concentration in Adults with Cyanosis from Congenital Heart Disease. Am J Cardiol. 2011; 107: 595-9Broberg C.S., Jayaweera A.R., Diller G.P. et al. Seeking the Optimal Relation between Oxygen Saturation and Hemoglobin Concentration in Adults with Cyanosis from Congenital Heart Disease. Am J Cardiol. 2011; 107: 595-9Broberg C.S., Jayaweera A.R., Diller G.P. et al. Seeking the Optimal Relation between Oxygen Saturation and Hemoglobin Concentration in Adults with Cyanosis from Congenital Heart Disease. Am J Cardiol. 2011; 107: 595-9

The authors declare that there are no conflicts of interest present.