The clinical condition of dysmetabolic hyperferritinemia (DHF) is defined in the presence of non-alcoholic fatty liver disease (NAFLD), metabolic syndrome alterations, and increased ferritin levels. Hyperferritinemia and iron stores have been associated with liver damage and susceptibility to vascular damage in NAFLD. However, conflicting data have been reported on the role of iron in atherosclerosis and heart disease, with recent evidence suggesting that excess iron induces vascular damage and could predispose to heart disease. We aimed at assessing cardiac function and the presence of cardiac siderosis in DHF with cardiac magnetic resonance (CMR).
Between 2009 and 2018 we enrolled patients (pts) with DHF (pts with NAFLD with alcohol assumption < 20 and 30 g/day for females and males, at least one feature of the metabolic syndrome, ferritin > 450 µg/L, normal or only mildly increased transferrin saturation); pts with iron storage disease and inflammatory disease were excluded. Pts underwent CMR on a 1.5 Tesla clinical scanner, the protocol included SSFP cines, dark-blood multi-echo T2* sequence and MOLLI T1 mapping sequence. Images were analyzed with validated commercial software.
Thirty-four pts were enrolled, mean age was 58±13 years, 29 were men (85%), mean ferritin was 903±332 µg/L. Left ventricular end diastolic and end systolic indexed volumes (EDV-I 68±17 ml/m2; ESV-I 23±7ml/m2), indexed mass (68±16 g/m2) and ejection fraction (66±8%) were normal. Mean T2* was within normal range (33±6 ms), mean MOLLI T1 was (976±27ms). As previously demonstrated, there was no correlation between T2* values and ferritin, neither between T2* and MOLLI T1 values, being T2* in the normal range. There was a significant but weak inverse relation between ferritin and MOLLI T1-values (p< 0.05, R= -0.34).
In a small cohort of pts with DHF, CMR demonstrated normal cardiac systolic function and absence of cardiac siderosis. Unlike T2* values, MOLLI T1 values were weakly related to ferritin values. Further studies are warranted to explore subtler cardiac dysfunction in DHT and to understand if MOLLI T1 could be correlated to hyperferritinemia and reflect mild cardiac siderosis in these pts.