Successful reversal by chelation therapy of congestive cardiomyopathy due to iron overload

Abstract

A patient who developed severe iron overload cardiomyopathy is described. Venesection could not be performed because the patient had chronic anemia. Deferoxamine mesylate, a chelating agent, was administered daily for more than 2 years and produced significant improvement in ventricular function which was associated with a biopsy-proven decrease in myocardial iron stores. This is the first reported case in which a severe cardiomyopathy due to iron overload was reversed by chelation therapy alone.

High Incidence of Cardiomyopathy in Beta-Thalassaemia Patients Receiving Regular Transfusion and Iron Chelation: Reversal by Intensified Chelation

“…Continuous intravenous DFX chelation in 4 of the 60 patients resulted in a marked increase in the uri nary iron excretion and hence in a better iron balance with a concomitant improvement in the LVEF in the 2 patients studied, and a return from atrial fibrillation to sinus rhythm in a third [11], This reversal of cardiac dysfunction with more intensive chelation has been well described previously [4,8,15].…”

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

“…120 Treatment with phlebotomy or iron chelation therapy can reverse the ventricular dysfunction. 121 On the basis of these reports, the Writing Group recognizes that divergent evidence exists with regard to the utility of EMB in this clinical scenario. The Writing Group recommends that EMB may be considered in the setting of unexplained heart failure of Ͼ3 months' duration associated with a dilated left ventricle, without new ventricular arrhythmias, or Mobitz type II second-or third-degree AV heart block, that responds to usual care within 1 to 2 weeks (Class of Recommendation IIb, Level of Evidence C).…”

Potential of the Right Ventricular Endomyocardial Biopsy to Diagnose and Assist in the Management of Congestive Heart Failure: Insights From Recent Clinical Trials

“…54 Initiating treatment with phlebotomy or iron chelation therapy can reverse the ventricular dysfunction. 55 It is essential that patients presenting with subacute or chronic heart failure due to idiopathic DCM first be managed for heart failure with current, state-of-the-art medical treatment. 56 Medical therapy in these cases is the same as that for heart failure in general, including β-adrenergic blockers, angiotensin-converting enzyme inhibitors, diuretics for signs of volume overload, and spironolactone or eplerenone.…”