Iron Overload Cardiomyopathy

Authors

  • Retno Eka Sari Undergraduate Program of Medicine, Department of Internal Medicine, Faculty of Medicine, Universitas Andalas, Padang 25175, Indonesia
  • Wahyudi Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Universitas Andalas, Padang 25175, Indonesia

DOI:

https://doi.org/10.32734/sumej.v7i3.17796

Keywords:

Calcium Channel Blocker, Cardiomyopathy, Iron Overload

Abstract

Iron overload cardiomyopathy is a condition of excessive iron accumulation in cardiomyocytes due to abnormal iron absorption or repeated blood transfusion. In the early stages, the patient may be asymptomatic with good ventricular systolic function. Iron deposit in ventricular cause dyspnea on effort due to left ventricular systolic dysfunction then in atrial cause atrioventricular block and supraventricular arrhythmic. For severe symptom due to dilated cardiomyopathy is characterized by left ventricular dilatation and risk of sudden cardiac death. Diagnosis of iron overload cardiomyopathy can be made if there is evidence of heart disease, the presence of iron overload (serum ferritin > 300 ng/mL and transferrin saturation > 55%) and cardiac siderosis with cardiac MRI T2 * < 20 ms as gold standard. Patient management involves lowering systemic iron levels and preventing iron entry into cardiomyocytes. Therapy with phlebotomy or iron chelation as indicated. Administration of calcium channel blockers and resveratrol antioxidant therapy may be considered to reduce morbidity and mortality due to cardiac siderosis.

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References

Y. Aydinok, et al., “Prevalence and distribution of iron overload in patients with transfusion-dependent anemias differs across geographic regions: Results from the CORDELIA study,” Eur J Haematol, vol. 95, no. 3, pp. 244–253, 2015. https://doi.org/10.1111/ejh.12487.

H. Zhang, P. Zhabyeyev, S. Wang, and G.Y. Oudit, “Role of iron metabolism in heart failure: From iron deficiency to iron overload,” Biochim Biophys Acta Mol Basis Dis, vol. 1865, no. 7, pp. 1925–1937, 2019. https://doi.org/10.1016/j.bbadis.2018.08.030.

E.C. Chapchap, et al., “Cardiac iron overload evaluation in thalassaemic patients using T2* magnetic resonance imaging following chelation therapy: a multicentre cross-sectional study,” Hematol Transfus Cell Ther, vol. 45, no. 1, pp. 7–15, 2023, https://doi.org/10.1016/j.htct.2021.01.014.

A. Albakri, “Iron overload cardiomyopathy: A review of literature on clinical status and meta-analysis of diagnostic and clinical management using iron chelators,” Internal Medicine and Care, vol. 2, no. 1, 2018. https://doi.org/10.15761/imc.1000117.

D.T. Kremastinos and D. Farmakis, “Iron overload cardiomyopathy in clinical practice,” 2011. https://doi.org/10.1161/CIRCULATIONAHA.111.050773.

T.A. McDonagh, et al., “2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure,” 2021, Oxford University Press. https://doi.org/10.1093/eurheartj/ehab368.

J.L. Fernandes, et al., “Amlodipine reduces cardiac iron overload in patients with thalassemia major: A pilot trial,” American Journal of Medicine, vol. 126, no. 9, pp. 834–837, 2013. https://doi.org/10.1016/j.amjmed.2013.05.002.

G.Y. Oudit and P.H. Backx, “Amlodipine Therapy for Iron-Overload Cardiomyopathy: The Enduring Value of Translational Research,” Pulsus Group Inc., 2016. https://doi.org/10.1016/j.cjca.2015.11.017.

P. Zhabyeyev, C. Sadasivan, S. Shah, F. Wang, and G.Y. Oudit, “Amlodipine rescues advanced iron overload cardiomyopathy in hemojuvelin knockout murine model: Clinical implications,” Front Cardiovasc Med, vol. 10, 2023. https://doi.org/10.3389/fcvm.2023.1129349.

J.L. Fernandes, et al., “A randomized trial of amlodipine in addition to standard chelation therapy in patients with thalassemia major,” Blood, vol. 128, no. 12, pp. 1555–1561, 2016. https://doi.org/10.1182/blood-2016-06-721183.

A. Khaled, H.A. Salem, D.A. Ezzat, H.M. Seif, and H. Rabee, “A randomized controlled trial evaluating the effects of amlodipine on myocardial iron deposition in pediatric patients with thalassemia major,” Drug Des Devel Ther, vol. 13, pp. 2427–2436, 2019. https://doi.org/10.2147/DDDT.S211630.

S.K. Das, et al., “Advanced iron-overload cardiomyopathy in a genetic murine model is rescued by resveratrol therapy,” Biosci Rep, vol. 38, no. 1, 2018. https://doi.org/10.1042/BSR20171302.

A. Paterek, U. Mackiewicz, and M. Mączewski, “Iron and the heart: A paradigm shift from systemic to cardiomyocyte abnormalities,” Wiley-Liss Inc., 2019. https://doi.org/10.1002/jcp.28820.

S. Kumfu, S.C. Chattipakorn, and N. Chattipakorn, “Iron overload cardiomyopathy: Using the latest evidence to inform future applications,” SAGE Publications Inc., https://doi.org/10.1177/15353702221076397.

S. Kumfu, N. Siri-Angkul, S.C. Chattipakorn, and N. Chattipakorn, “Silencing of lipocalin-2 improves cardiomyocyte viability under iron overload conditions via decreasing mitochondrial dysfunction and apoptosis,” J Cell Physiol, vol. 236, no. 7, pp. 5108–5120, 2021. https://doi.org/10.1002/jcp.30219

N. Sumneang, N. Siri-Angkul, S. Kumfu, S. C. Chattipakorn, and N. Chattipakorn, “The effects of iron overload on mitochondrial function, mitochondrial dynamics, and ferroptosis in cardiomyocytes,” Academic Press Inc., 2020. https://doi.org/10.1016/j.abb.2019.108241.

M.J. Zimmerman, D.R. Rosing, and Y. Shizukuda, “Advancement of echocardiography for surveillance of iron overload cardiomyopathy: comparison to cardiac magnetic resonance imaging,” Springer Japan, 2021. https://doi.org/10.1007/s12574-021-00524-x.

J.P. Carpenter, et al., “On T2* magnetic resonance and cardiac iron,” Circulation, vol. 123, no. 14, pp. 1519–1528, 2011. https://doi.org/10.1161/CIRCULATIONAHA.110.007641.

G. Yang, R. Liu, P. Peng, L. Long, X. Zhang, W. Yang, et al., “How early can myocardial iron overload occur in beta thalassemia major?” Plos One, 2014

T.D. Atmakusuma, R. Kalwani, S.A. Nasution, and M. Rumende, “Correlation of Serum Ferritin and Cardiac Iron Toxicity with Cardiac Function in Transfusion Dependent Beta-Thalassemia Major Patients,” 2021.

P.A. Wahidiyat, S.D. Iskandar, D. Sekarsari, and P. Amalia Wahidiyat, “Evaluation of Iron Overload Between Age Groups Using Magnetic Resonance Imaging and Its Correlation with Iron Profile in Transfusion-dependent Thalassemia,” 2018.

A. Eghbali, S. Mehrabi, Y. Ghandi, A. Eghbali, M. Dabiri, and M. Mousavi-Hasanzadeh, “Serum markers and cardiac T2* MRI in thalassemia major The Correlation between Serum Ferritin, Serum Troponin T, cardiac T2* MRI and Echocardiographic Findings in Patients with Thalassemia Major,” 2020. [Online]. Available: www.ijbc.ir

H.K. Heris, et al., “Evaluation of iron overload by cardiac and liver T2∗ in β-thalassemia: Correlation with serum ferritin, heart function and liver enzymes,” J Cardiovasc Thorac Res, vol. 13, no. 1, pp. 54–60, 2021. https://doi.org/10.34172/jcvtr.2021.18.

H. Darvishi-Khezri et al., “Ferritin thresholds for cardiac and liver hemosiderosis in β-thalassemia patients: a diagnostic accuracy study,” Sci Rep, vol. 12, no. 1, Dec. 2022, doi: 10.1038/s41598-022-22234-9.

A. Bruzzese, et al., “Iron chelation therapy,” John Wiley and Sons Inc., 2023. https://doi.org/10.1111/ejh.13935.

S. Entezari et al., “Iron Chelators in Treatment of Iron Overload,” Hindawi Limited, 2022. https://doi.org/10.1155/2022/4911205.

R. Origa, et al., “Safety and Efficacy of the New Combination Iron Chelation Regimens in Patients with Transfusion-Dependent Thalassemia and Severe Iron Overload,” J Clin Med, vol. 11, no. 7, 2022. https://doi.org/10.3390/jcm11072010.

E. Faheri, R. Hidayat, et al., “Update in Diagnostic Procedure and Treatment in Internal Medicine: Towards Evidence Based Competency” Kumpulan Makalah Pertemuan Ilmiah Nasional ke XIX Perhimpunan Dokter Spesialis Penyakit Dalam Indonesia. Editor.”

T.Y. Chuang, J.P. Li, T.F. Weng, K.H. Wu, and Y.H. Chao, “Combined chelation with high-dose deferiprone and deferoxamine to improve survival and restore cardiac function effectively in patients with transfusion-dependent thalassemia presenting severe cardiac complications,” Ann Hematol, vol. 99, no. 10, pp. 2289–2294, 2020. https://doi.org/10.1007/s00277-020-04196-y.

F. Vinchi, S. Hell, and U. Platzbecker, “Controversies on the consequences of iron overload and chelation in MDS,” Hemasphere, vol. 4, no. 3, 2020, https://doi.org/10.1097/HS9.0000000000000357.

Published

2024-09-05

How to Cite

1.
Eka Sari R, Wahyudi. Iron Overload Cardiomyopathy. Sumat. Med. J. [Internet]. 2024Sep.5 [cited 2024Nov.16];7(3):159-67. Available from: https://talenta.usu.ac.id/smj/article/view/17796