Echocardiographic characteristics related to chronic iron overload in patient with aplastic anemia

Background and Objectives: In patients with aplastic anemia, chronic iron overload due to multiple blood transfusions, leads to secondary hemochromatosis. Cardiac involvement in hemochromatosis is the leading cause of death. The goal of this study was to find the echocardiographic characteristics of patients with aplastic anemia and chronic iron overload. Subjects and Methods: Echocardiography was performed on 33 patients with aplastic anemia (age 33±10, M: F=14: 19) and 15 controls (age 34±8, M: F=6: 9). The regions of interest on digitalized 2-D images of the papillary muscle (PM) in the parasternal short-axis view and the interventricular septum (IVS) in the apical 4-chamber view were analyzed using histograms, which quantified the echoreflectiveness (256 gray scales; black=0, white=255) of the myocardium. The echocardiographic parameters of each group were compared, including wall thickness, chamber dimensions, systolic, diastolic function indexes and echoreflectiveness. The aplastic anemic patients were divided into two groups (22 with serum ferritin level ≥2,000 μg/L vs. 11 with <2,000 μg/L) and then compared. Results: The right ventricular (RV) wall was thicker in the patients than the controls (4.1 ± 1.2 mm vs. 2.6±0.5 mm, p<0.01). In the patients, the echoreflectiveness of the PM was typically higher than in the controls (gray scale, 173.9±40.9 vs. 80.72±34.1, p<0.01), with IVS showing higher reflectivity, but this was not statistically significant (80.4±16.6 vs. 75.2±13.7, p=0.41). Patients with a ferritin level (2,000 μg/L had a thicker RV wall (4.4±1.2 mm vs. 3.3±0.6 mm, p=0.01) and larger left atrium (LA) dimension (38.1±1.4 mm vs. 32.2±1.9 mm, p=0.02) than those with a ferritin level<2,000 ±g/L. No considerable difference was found between the echoreflectiveness of each group. Conclusion: The echocardiographic findings, such as high echoreflectiveness in the PM, RV wall hypertrophy and LA dilation, might be characteristics suggestive of early myocardial changes due to chronic iron overload as a result of multiple transfusions.