{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:26:55Z","timestamp":1772252815651,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T00:00:00Z","timestamp":1749254400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"CSL Vifor","award":["IS-HUB-004\/21"],"award-info":[{"award-number":["IS-HUB-004\/21"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Iron deficiency (ID) is a commonly seen comorbidity in heart failure (HF) patients. It is often associated with a poor prognosis and impaired physical capacity. The functional limitations linked to ID may lead to cardiac function abnormalities. The functional limitations linked to ID may lead to cardiac function abnormalities, that can be reversible after iron repletion. Some echocardiographic parameters, such as global longitudinal strain (GLS), myocardial work (MW) and its derivatives constructive work (CW), wasted work (WW) and work efficiency (WE), may be of added value in advanced cardiac performance assessment. Methods: IRON-PATH II was a multicenter, prospective and observational study designed to describe the pathophysiological pathways associated with ID. The echo-substudy included 100 HF patients that had undergone a specific pilot echocardiographic evaluation. Patients had a left ventricular ejection fraction (LVEF) \u226450%, were in stable clinical condition and on standard HF medication with hemoglobin \u226511 g\/dL. The final cohort included 98 patients. Results: The ID group showed worse cardiac function, with lower GLS (\u22128.5 \u00b1 9% vs. \u221210 \u00b1 10%), WE (74 \u00b1 10% vs. 80 \u00b1 10%) and MW (665 [453\u20131013] vs. 947 [542\u20131199] mmHg%), as well as higher WW (290 [228\u2013384] vs. 212 [138\u2013305] mmHg%) and lower RV free wall strain (\u221213 [\u221220\u2013(\u221211)]% vs. \u221217 [\u221223\u2013(\u221214)]%). Following iron repletion, ID patients demonstrated improved LV (GLS, MW, WE and WW) and RV performance (RV free wall strain), aligning with non-ID patients (all p-values &gt;0.05 compared to the non-ID group). Conclusions: Among HF patients with reduced LVEF, ID was associated with worse myocardial performance in both the LV and RV. All the alterations seen were reversible after intravenous iron repletion.<\/jats:p>","DOI":"10.3390\/jcm14124048","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T05:54:05Z","timestamp":1749448445000},"page":"4048","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Myocardial Performance Improvement After Iron Replacement in Heart Failure Patients: The IRON-PATH II Echo-Substudy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7475-4145","authenticated-orcid":false,"given":"Ra\u00fal","family":"Ramos-Polo","sequence":"first","affiliation":[{"name":"Cardiology Department, Heart Institute, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-2916-2374","authenticated-orcid":false,"given":"Maria del Mar","family":"Ras-Jim\u00e9nez","sequence":"additional","affiliation":[{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain"},{"name":"Department of Internal Medicine, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0420-1507","authenticated-orcid":false,"given":"Mar\u00eda del Carmen","family":"Basalo Carbajales","sequence":"additional","affiliation":[{"name":"Cardiology Department, Heart Institute, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0358-0840","authenticated-orcid":false,"given":"S\u00edlvia","family":"Jovells-Vaqu\u00e9","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5999-5741","authenticated-orcid":false,"given":"Jos\u00e9 Manuel","family":"Garcia-Pinilla","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cardiology Department, Virgen de la Victoria Hospital, 29010 Malaga, Spain"},{"name":"IBIMA-Platafrma BIONAND, 29590 Malaga, Spain"},{"name":"Department of Medicine and Dermatology, Universidad of M\u00e1laga, 29071 Malaga, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Cobo-Marcos","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cardiology Department, Puerta de Hierro University Hospital, 28222 Majadahonda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9847-687X","authenticated-orcid":false,"given":"Javier","family":"de Juan-Bagud\u00e1","sequence":"additional","affiliation":[{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Cardiology Department, Instituto de Investigaci\u00f3n Sanitaria Hospital 12 de Octubre (imas12), 12 de Octubre University Hospital, 28041 Madrid, Spain"},{"name":"Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3019-5956","authenticated-orcid":false,"given":"C\u00e2ndida","family":"Fonseca","sequence":"additional","affiliation":[{"name":"Heart Failure Cl\u00ednic, S. Francisco Xavier Hospital, Department of Medicine, ULS Lisboa Ocidental, NOVA Medical School, Universidade Nova de Lisboa, 1150-190 Lisboa, Portugal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Josep","family":"Francesch Manzano","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1222-9047","authenticated-orcid":false,"given":"Andreea Eunice","family":"Cosa","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4858-9566","authenticated-orcid":false,"given":"Sergi","family":"Yun-Viladomat","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Internal Medicine, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina","family":"Enjuanes","sequence":"additional","affiliation":[{"name":"Cardiology Department, Heart Institute, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Tajes Ordu\u00f1a","sequence":"additional","affiliation":[{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8780-720X","authenticated-orcid":false,"given":"Josep","family":"Comin-Colet","sequence":"additional","affiliation":[{"name":"Cardiology Department, Heart Institute, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L\u2019Hospitalet de Llobregat, 08908 Barcelona, Spain"},{"name":"Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L\u2019Hospitalet de Llobregat, 08907 Barcelona, Spain"},{"name":"Centro de Investigaci\u00f3n Biom\u00e9dica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain"},{"name":"Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, 08007 Barcelona, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"522","DOI":"10.1002\/ejhf.640","article-title":"Myocardial iron content and mitochondrial function in human heart failure: A direct tissue analysis","volume":"19","author":"Melenovsky","year":"2017","journal-title":"Eur. 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