Cardiac function during iron chelation therapy in adult non-thalassaemic patients with transfusional iron overload

• Published in: European journal of haematology 1997-10, Vol.59 (4), p.221-230
• Main Authors: Jensen, P. D., Olsen, N., Bagger, J. P., Jensen, F. T., Christensen, T., Ellegaard, J.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aging; Antidotes - administration & dosage; Ascorbic Acid - administration & dosage; beta-Thalassemia - physiopathology; beta-Thalassemia - therapy; Biological and medical sciences; cardiac ejection fraction; Chelating Agents - administration & dosage; Coronary Angiography; Deferoxamine - administration & dosage; desferrioxamine; Drug toxicity and drugs side effects treatment; Female; Humans; Injections, Subcutaneous; iron chelation; Iron Overload - drug therapy; Iron Overload - etiology; Iron Overload - physiopathology; Male; Medical sciences; Middle Aged; MUGA; Pharmacology. Drug treatments; Toxicity: cardiovascular system; Transfusion Reaction; transfusional iron overload; Ventricular Function, Left - drug effects; vitamin C
• ISSN: 0902-4441; 1600-0609
• DOI: 10.1111/j.1600-0609.1997.tb00981.x

: It is well‐documented that iron chelation by desferrioxamine protects/improves the cardiac function in blood transfusion‐dependent children suffering from ß‐thalassaemia. In patients who do not become dependent upon blood transfusion until adulthood (ANT‐patients), iron chelation by desferrioxamine may affect the cardiac function in unknown ways, presumably because age‐related changes in the heart may cause iron chelation to affect the cardiac function in different ways. We therefore followed the left ventricular ejection fraction (LVEF) by multigated radionuclide angiography in 16 iron‐loaded ANT‐patients during iron chelation alone and after increasing the efficacy of chelation by vitamin C supplementation. During 12 months of iron chelation the mean LVEF fell significantly from 63.3% to 58.0% (p = 0.04). Individual changes in LVEF did not correlate significantly with age but with the pretreatment liver iron concentration. After initiation of vitamin C supplementation, the mean LVEF increased from 55.9% to 65.3% (p = 0.01). Our data suggest that in ANT‐patients prolonged desferrioxamine treatment without vitamin C supplementation may be associated with reduced LVEF, whereas vitamin C supplementation seems to benefit the cardiac function. Similar findings have not been described in ß‐thalassaemia and may hence be specific for ANT‐patients. However, our findings have to be confirmed by controlled studies.