Background: In hematologic patients undergoing repeated transfusions, iron overload may cause dilated cardiomyopathy and arrhythmias. After excluding coronary artery disease, tissue characterization by cardiac magnetic resonance (CMR) enables the diagnosis of cardiac siderosis. Case presentation: A 56-year-old man with a myeloproliferative neoplasm on ruxolitinib, candidate for allogeneic transplantation, had a history of multiple transfusions. Personal and family cardiac history was unremarkable. Cardiovascular risk factors included arterial hypertension. He presented with dyspnea and a 10-kg weight gain over 20 days, with new peripheral edema. A 24-h Holter for palpitations showed infrequent premature ventricular complexes, often in couplets/triplets, and brief non-sustained ventricular tachycardia (maximum 4 beats). ECG showed sinus rhythm, left bundle branch block, mild ST-segment depression and inferolateral T-wave inversion. Laboratory tests showed mild leukopenia and anemia, with BNP 1,646 pg/mL. Transthoracic echocardiography revealed a dilated left ventricle with LVEF 45% due to diffuse hypokinesia; right-sided chambers were normal; moderate tricuspid regurgitation was present; the inferior vena cava was dilated with reduced collapsibility. He was admitted for acute decompensated heart failure with newly detected left ventricular dysfunction. Coronary angiography showed no angiographically significant stenoses. CMR demonstrated a severely dilated left ventricle with LVEF 37% and diffuse hypokinesia, globally reduced native T1 with increased extracellular volume, and a markedly hypointense liver, overall consistent with myocardial and hepatic iron deposition. The patient continued hematologic therapy with cardiology follow-up, but died a few months later due to pneumonia complicated by septic shock. Discussion/Conclusions: In heavily transfused patients presenting with heart failure and/or ventricular arrhythmias, iron-overload cardiomyopathy should be considered. CMR provides a non-invasive diagnosis and may guide management.
Associazione Nazionale Medici Cardiologi Ospedalieri
