IRONMET-HFpEF
a single ferric derisomaltose infusion improves peak VO2, walking distance and NYHA class at twelve weeks in HFpEF with iron deficiency, but not patient-reported health status
Presented in FS.07 at AHA 2026 (Sunday 8 November, Gregory D. Lewis, Mass General Brigham, Boston) and published simultaneously in Circulation. IRONMET-HFpEF is a single-centre, double-blind, placebo-controlled trial in 65 patients with symptomatic HFpEF and iron deficiency (ferritin below 100 ng/mL, or below 300 with transferrin saturation below 20 percent), enrolled between December 2021 and April 2026 and randomised 2:1 to a single intravenous dose of ferric derisomaltose 1,000 mg (44) or placebo (21). Median age 68, 72 percent women, transferrin saturation 16 percent, ferritin 58 ng/mL; 64 completed. Primary endpoint: change in peak oxygen uptake from baseline to 12 weeks. Peak VO2 improved by 1.2 mL/kg/min (95 percent CI 0.6 to 1.7) with iron and 0.1 (minus 0.7 to 0.9) with placebo, least-squares mean difference 1.1 (0.2 to 1.9), P = 0.02, from a median baseline of 12.7 and 12.2 mL/kg/min. VO2 at the anaerobic threshold, 6-minute walk distance and NYHA class also improved (all P below 0.05); the KCCQ overall summary score did not (plus 4.4, minus 2.4 to 11.2, P = 0.20). Transferrin saturation rose by 9.4 points and ferritin by 183 ng/mL versus placebo. No serious adverse events related to the infusion. The largest exercise-capacity trial of iron repletion in HFpEF to date; the editorial (Fudim and Ambrosy) is titled 'An Endpoint Is Not Yet an Indication'.
Join us
Join the Global Primary Care Cardio Network. Membership is free.
Would you like to tell us more about yourself?
Interests
We will send you an email with a link to confirm your registration.
