Hemodynamic Response to Treatment of Iron Deficiency Anemia in Pulmonary Arterial Hypertension: Longitudinal Insights from an Implantable Hemodynamic Monitor
Abstract
<jats:p> Despite new therapeutic options, pulmonary arterial hypertension (PAH) remains
a progressive disease associated with substantial morbidity and mortality. As such,
additional strategies for monitoring and adjunctive management of this disease are
important. A 59-year-old woman with scleroderma-associated PAH received an implantable
hemodynamic monitor (IHM) as part of a research protocol at our institution. Pulmonary
artery pressures, heart rate, and cardiac output (sensor-based algorithm) were measured
on a daily basis, and parameters of right ventricular (RV) performance and afterload
were calculated. At the time of IHM implant, the patient had functional class III
symptoms, was receiving triple-drug therapy, and had normal hemoglobin levels. Four
months after implant, and with further optimization of prostacyclin therapy, she had
improvement in her symptoms. However, shortly thereafter, while the patient was receiving
stable drug therapy, her case regressed with worsening symptoms, and the patient received
a new diagnosis of iron deficiency anemia. Oral iron supplementation resulted in normalization
of hemoglobin levels and improvement in the patient's iron profile. A gradual and
sustained reduction in pulmonary pressures was noted after initiation of oral iron
accompanied by increased RV performance and favorable reduction in RV afterload. The
patient had significant symptomatic improvement. Iron deficiency is an underappreciated
yet easily treatable risk factor in PAH. Use of IHM in this case longitudinally illustrates
the optimization of pulmonary hemodynamics and RV afterload in tandem with clinical
improvement achieved by a simple therapy. </jats:p>
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https://hdl.handle.net/10161/22033Published Version (Please cite this version)
10.1086/688670Publication Info
Mehmood, Muddassir; Agarwal, Richa; Raina, Amresh; Correa‐Jaque, Priscilla; & Benza,
Raymond L (2016). Hemodynamic Response to Treatment of Iron Deficiency Anemia in Pulmonary Arterial
Hypertension: Longitudinal Insights from an Implantable Hemodynamic Monitor. Pulmonary Circulation, 6(4). pp. 616-618. 10.1086/688670. Retrieved from https://hdl.handle.net/10161/22033.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
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Richa Agarwal
Associate Professor of Medicine
Division of Cardiology, Section of Advanced Heart Failure and Cardiac Transplantation

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