Effect of Intravenous Ferrous Sucrose on Exercise Capacity in Chronic Heart Failure

Inclusion Criteria: ≥21 years of age and have signed written informed consent Stable symptomatic CHF; NYHA III/IV and left ventricular ejection fraction (LVEF) ≤40%, or if NYHA II then LVEF must be ≤35%, as assessed within last 6 months using echocardiographic or magnetic resonance imaging techniques. On optimal conventional therapy for at least 4 weeks prior to recruitment and without dose changes for at least 2 weeks. Peak VO2 ≤ 18 ml/kg/min on modified Naughton protocol cardiopulmonary exercise testing. Mean of the 2 screening Hb concentrations (week-2 and week-1) < 12.5 g/dl (anaemic group, 50% of study population) or 12.5-14.0 g/dl (non-anaemic group, 50% of study population). Ferritin <100 µg/l or 100-300 µg/l with TSAT <20%. Normal red cell folate and vitamin B12 status (according to local lab reference range). Resting blood pressure ≤160/100 mmHg. Exclusion Criteria: History of acquired iron overload; known haemochromatosis or first relatives with haemochromatosis; and allergic disorders (asthma, eczema, and anaphylactic reactions). Known hypersensitivity to parental iron preparations. Known active infection, bleeding, malignancy and haemolytic anaemia. History of chronic liver disease and/or alanine transaminase (ALT) or aspartate transaminase (AST) >3 times the upper limit of the normal range; chronic lung disease; myelodysplastic disorder; and known HIV/AIDS disease. Recipient of immunosuppressive therapy or renal dialysis. History of erythropoietin, IV or oral iron therapy, and blood transfusion in previous 30 days. Unstable angina pectoris, as judged by the investigator; severe uncorrected valvular disease or left ventricular outflow obstruction; obstructive cardiomyopathy; uncontrolled fast atrial fibrillation or flutter (heart rate >110 beats per minute [bpm]); uncontrolled symptomatic brady- or tachyarrhythmias. Musculoskeletal limitation that, in the judgement of the investigator, would impair cardiopulmonary exercise testing. Pregnant or breast-feeding Inability to comprehend study protocol Parallel participation in another clinical trial