Improvements in cardiac function detected using echocardiography in patients with hereditary haemochromatosis.

Abstract

Hereditary haemochromatosis is often not diagnosed until adulthood. Iron overload cardiomyopathy initially results in diastolic dysfunction and can result in arrhythmias and irreversible cardiac failure if untreated. The aim of this study was to investigate whether patients with newly diagnosed hereditary haemochromatosis without signs of heart failure exhibit subclinical alterations of cardiac function and to determine if cardiac function improved after 1year of venesection. Baseline echocardiography was performed on 25 patients with newly diagnosed hereditary haemochromatosis with elevated serum ferritin levels. The test was repeated after 1year of treatment with venesection. Tissue Doppler imaging (TDI) and deformation (strain) imaging using speckle tracking were performed. Left atrial force was measured according to the Newtonian principle, in which force (dynes) = mass × acceleration. Left atrial force was calculated by the Manning method expressed as ρ × 0.53 × mitral annular orifice area × (peak A velocity)2. Radial strain showed a significant improvement after 1year of venesection (increase from 38.8 to 52.6). The LAF showed a significant decrease after 1year of venesection (median decrease = 0.6 (IQR 0, 1.60), p= 0.0004). Iso-volumetric relaxation time (IVRT) decreased significantly in patients after 1year of venesection (decrease from 107.4 ± 16.2 to 97.68 ± 15.4ms, p (0.0187)). Among all measurements, radial strain, IVRT and left atrial force were shown to significantly improve following a 1-year course of venesection, suggesting that these parameters could be used to identify subclinical cardiac dysfunction in patients with iron overload secondary to hereditary haemochromatosis and to guide intensification of venesection therapy.