Extensive myocardial iron deposition in a patient with hepatitis C

During a cardiac evaluation prior to liver transplantation, a 51-year-old man with hepatitis C and cirrhosis was found to have nonischemic cardiomyopathy-a condition that would have made him ineligible for liver transplantation. Right ventricular biopsy revealed extensive cardiac hemosiderosis. Despite the elevated levels of serum ferritin, the patient had no history of multiple red blood cell transfusions; moreover, genetic testing for hereditary hemochromatosis was negative for the HFE mutations C282Y and H63D. Chelation therapy was considered for this patient, to reduce the cardiac iron deposits. However, before a course of treatment was established, the patient's clinical condition worsened, and chelation therapy was no longer feasible. He was referred for combined heart and liver transplantation. Cardiac iron deposition can be diagnosed readily using right ventricular biopsy or T2* magnetic resonance imaging. Early detection may allow time for intensive chelation therapy, which might, in turn, reverse the myopathic process. Improved cardiac function should improve cirrhosis patients' chances to be placed on the liver transplant waiting list and ultimately optimize transplantation outcomes.