Extensive myocardial iron deposition in a patient with hepatitis C

Arthur Rusovici1, Samia Ibrahim, Sunita Sood

  • 1Division of Cardiology, Department of Medicine, University of Medicine & Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey 07103, USA. arusovici1@yahoo.com

Insights

This study details a patient with nonischemic cardiomyopathy and cardiac hemosiderosis, highlighting the diagnostic importance of cardiac iron deposition in liver transplant candidates. Early detection and chelation therapy are crucial for improving outcomes.

Area of Science:

  • Cardiology
  • Hepatology
  • Transplantation Medicine

Background:

  • Liver transplantation eligibility is often contingent on cardiac health.
  • Nonischemic cardiomyopathy can be a contraindication for liver transplantation.
  • Cardiac hemosiderosis, or iron overload in the heart, presents diagnostic challenges.

Observation:

  • A 51-year-old man with hepatitis C and cirrhosis developed nonischemic cardiomyopathy.
  • Right ventricular biopsy revealed extensive cardiac hemosiderosis.
  • Elevated serum ferritin and cardiac iron deposition were present, without typical hemochromatosis markers or transfusion history.

Findings:

  • Cardiac iron deposition was diagnosed via right ventricular biopsy.
  • Chelation therapy was considered but became infeasible due to clinical deterioration.
  • The patient was referred for combined heart and liver transplantation.

Implications:

  • Cardiac iron deposition can be diagnosed using right ventricular biopsy or T2* MRI.
  • Early detection of cardiac iron allows for potential chelation therapy to reverse myopathy.
  • Improved cardiac function enhances eligibility for liver transplant waiting lists and optimizes outcomes.

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