Improvement in Severe Mitral Regurgitation and Left Ventricular Dysfunction with Intravenous Iron in Severe Anemia: A Case Report.

BACKGROUND: Anemia and iron deficiency are frequently observed in patients with heart failure (HF) and are independently linked to adverse outcomes. Although intravenous (IV) iron supplementation is well studied in HF with reduced ejection fraction, its impact on coexisting significant valvular disease remains poorly understood.

CASE DESCRIPTION: A 67-year-old female with a known history of coronary artery disease, diabetes, hypertension, hypothyroidism, and chronic kidney disease presented with exertional breathlessness and fatigue. Workup revealed severe anemia (hemoglobin 6.1 gm/dL), reduced left ventricular ejection fraction (LVEF 45%), severe mitral regurgitation (MR), and mild tricuspid regurgitation (TR). She was managed conservatively with IV iron and two units of leukocyte-depleted packed red blood cells (LD PRBCs). Over the next few days, the patient experienced marked clinical improvement. Repeat echocardiography demonstrated normalization of LVEF, downgrading of MR severity from severe to mild, regression of TR, and complete resolution of pericardial effusion. Her hemoglobin improved to 8.0 gm/dL.

DISCUSSION: This case underscores the role of severe anemia as a modifiable factor contributing to cardiac dysfunction, including reversible valvular insufficiency and reduced systolic performance. Restoration of hemoglobin levels led to significant clinical and echocardiographic recovery, pointing to anemia as a potential therapeutic target in such cases. The use of IV iron proved beneficial in facilitating this improvement.

CONCLUSION: In older patients with multiple comorbidities and new or worsening cardiac dysfunction, severe anemia should be considered a treatable cause. Early diagnosis and targeted therapy using IV iron and transfusion can result in substantial clinical gains and may help avoid unnecessary invasive procedures.