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Distinct Echocardiographic Phenotypes in Primary vs. Secondary Iron Overload Cardiomyopathy: A Pilot Study on

Luis Andrés Vega-Quesada1, Zuilma Yurith Vásquez-Ortiz1, María Elena Soto-López2

  • 1Department of Echocardiography, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City 14080, Mexico.

Medical Sciences (Basel, Switzerland)
|May 27, 2026
PubMed

Insights

Secondary hemochromatosis patients have worse iron overload cardiomyopathy outcomes than primary hemochromatosis patients. Myocardial work indices may offer insights into iron burden and cardiac toxicity beyond traditional measures.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Biomarkers

Background:

  • Iron overload cardiomyopathy (IOC) is a significant complication of hemochromatosis, potentially missed by conventional echocardiography.
  • Comparative analysis of myocardial work (MW) indices in primary (PH) versus secondary hemochromatosis (SH) is limited.

Purpose of the Study:

  • To compare echocardiographic phenotypes and myocardial work indices in PH and SH patients.
  • To investigate associations between iron burden and cardiac function using MW indices.

Main Methods:

  • Retrospective cross-sectional study of 34 hemochromatosis patients (16 PH, 18 SH).
  • Echocardiography with speckle-tracking for LV global longitudinal strain (GLS) and non-invasive MW indices (GWI, GCW, GWW, GWE).
  • Phenotypic classification: Normal, Dilated, Restrictive, RVPH.

Main Results:

  • SH patients had higher iron burden, neurohormonal activation, and mortality (33% vs 0%) despite similar LVEF and GLS.
  • PH patients predominantly had Normal phenotypes (81%), while SH patients showed more advanced phenotypes (RVPH, Dilated).
  • Global work index (GWI) correlated inversely with ferritin, especially in SH patients. Global wasted work (GWW) was higher in advanced phenotypes.

Conclusions:

  • Primary and secondary hemochromatosis present distinct IOC phenotypes, with SH associated with worse outcomes and advanced cardiac remodeling.
  • Myocardial work indices show potential as complementary tools to assess iron burden and cardiac toxicity, complementing LVEF and GLS.
  • These findings require validation in larger prospective studies.

Keywords:
echocardiographyglobal longitudinal strainglobal wasted workglobal work indexhemochromatosisiron overload cardiomyopathymyocardial work

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