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

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.