Cardiovasc Prev Pharmacother.  2023 Jul;5(3):81-90. 10.36011/cpp.2023.5.e11.

Relationship between serum ferritin levels during iron chelating therapy and diastolic left ventricular function in transfusion-induced iron overload: a 2-year follow-up study in patients with aplastic anemia

• Chung WB

• KMID: 2544631
• DOI: http://doi.org/10.36011/cpp.2023.5.e11

Abstract

Background
The goal of the study was to investigate changes in cardiac function during iron chelating therapy (ICT) in patients with transfusion-induced iron overload.
Methods
We prospectively examined cardiac function in 21 aplastic anemia patients for 2 years by using transthoracic echocardiography before and during ICT.
Results
The serum ferritin level decreased from 4,961.5±2,917.9 µg/L to 2,466.9±2,533.1 µg/L after 2 years (P<0.001). The left ventricular ejection fraction decreased to under the normal limit (55%) in five patients. The serum ferritin level was positively correlated with the E/E’ ratio (r=0.595, P=0.004) and the left atrial (LA) volume (r=0.685, P=0.001) and negatively correlated with the deceleration time (r=–0.586, P=0.005) after 2 years of ICT. The seven responders (serum ferritin level <1,000 µg/L after 2 years of ICT) demonstrated a significantly higher ejection fraction, smaller LA volume and left ventricular end-systolic dimension, and a slower deceleration time than the 14 nonresponders (≥1,000 µg/L).
Conclusions
These results suggest that the response to ICT, which was estimated by the serum ferritin level, can reflect cardiac function during ICT. In nonresponders, cardiac function monitoring during ICT may be helpful for the early detection of cardiac dysfunction.

Keyword

Aplastic anemia; Iron overload; Deferasirox; Echocardiograrphy

Figure

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  Fig. 1. Cardiac function and response monitoring during iron chelating therapy (ICT). Serum ferritin concentrations were measured regularly every 2 months, and transthoracic echocardiography (TTE) was conducted before ICT and at 6, 12, and 24 months of ICT.

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  Fig. 2. Relationship between serum ferritin levels and echocardiographic parameters of diastolic function. Left atrial (LA) volume, peak early mitral inflow velocity (E) to peak early diastolic annular velocity (E’) ratio, and deceleration time (DT) did not demonstrate a relationship with serum ferritin levels before iron chelating therapy with deferasirox. The LA volume and E/E’ ratio demonstrated positive correlations with serum ferritin levels, and the DT demonstrated negative correlations with ferritin levels after treatment. (A) Pretreatment and (B) posttreatment LA volume. (C) Pretreatment and (D) posttreatment E/E’ ratio. (E) Pretreatment and (F) posttreatment DT.

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