From the Guidelines
If an echocardiogram shows iron deposits in the heart, immediate medical attention from a cardiologist and hematologist is necessary to prevent severe heart failure, arrhythmias, or cardiomyopathy. The implications of echocardiogram showing iron deposits in the heart are significant, and treatment should be initiated promptly to prevent long-term cardiac damage. According to the most recent and highest quality study 1, iron overload in the heart can lead to restrictive cardiomyopathy with early diastolic dysfunction, which may progress to dilated cardiomyopathy with impaired systolic function. The study also highlights the importance of early detection and treatment, as iron removal therapy can prevent, improve, or even reverse cardiac dysfunction. Some key points to consider in the management of iron overload cardiomyopathy include:
- Regular monitoring of cardiac function, iron levels, and organ function during treatment
- Iron chelation therapy with medications such as deferoxamine (Desferal), deferasirox (Exjade, Jadenu), or deferiprone (Ferriprox)
- Regular phlebotomy (blood removal) may also be recommended if the patient is not anemic
- Cardiologist consultation is recommended in the presence of signs of possible cardiac involvement
- Conventional treatment should be initiated per standard cardiology practice in patients with heart failure and arrhythmias. It is essential to note that the rate and magnitude of circulatory and tissue iron overload determine the haemochromatosis phenotype, and the heart is particularly sensitive to a rapid and massive increase in plasma iron early in disease development 1. Therefore, a structured patient interview, physical examination, and cardiac investigations should be reasonably guided by the overall assessment of age at diagnosis, clinical manifestations, and cofactors of iron overload. In patients with HFE-haemochromatosis, a conservative approach with echocardiography and/or cardiac MRI is advisable, while in juvenile forms, all patients should be thoroughly investigated at the time of diagnosis, and follow-up should be adapted to the severity and stage of the disease, clinical manifestations, effectiveness of iron removal, and patient’s adherence to therapy 1.
From the Research
Implications of Iron Deposits in the Heart
The implications of an echocardiogram (echo) showing iron deposits in the heart are significant and can lead to various cardiac complications. Some of the key implications include:
- Cardiac iron overload, which can result in impaired left ventricular dysfunction 2
- Increased risk of heart failure and its complications 3
- Potential for decreased cardiac function and reduced left ventricular ejection fraction (LVEF) 4
Detection and Management
Detection and management of heart complications due to iron overload have improved dramatically over the years. Some of the key methods for detection and management include:
- Non-invasive techniques such as magnetic resonance imaging (MRI) to quantify iron burden 3, 4, 5
- Echocardiography to closely monitor cardiac functions associated with iron overload complications and mortality 3, 6
- Chelation therapy with iron chelators such as deferoxamine, deferiprone, and deferasirox to remove iron from the heart 3, 4, 2
Early Detection and Treatment
Early detection of cardiac iron overload is crucial to prevent long-term cardiac damage. Some of the key methods for early detection include:
- Echocardiographic longitudinal strain analysis to detect early cardiac functional impairment iron-related 6
- Biosusceptometry SQUID to quantify liver iron concentration and cardiac assessment by CMR T2* 6
- Combination chelation therapy with deferoxamine and deferiprone to effectively remove iron from the heart 5