Appalachian Regional Healthcare, Highlands Regional Medical Center, Cardiovascular Associates, 5000 KY-321, Prestonsburg, KY, 41653, USA.
Cardiovascular Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
J Echocardiogr. 2021 Sep;19(3):141-149. doi: 10.1007/s12574-021-00524-x. Epub 2021 Mar 26.
The prevalence of iron overload cardiomyopathy (IOC) is increasing. Patients with transfusion-dependent anemias or conditions associated with increased iron absorption over time are at a significant risk for the development of iron-overloaded states such as IOC. Current guidelines regarding the diagnostic evaluation and follow-up of patients at risk for IOC exist, and are composed of multiple components, including such as echocardiography, genetic testing, magnetic resonance imaging of liver, and cardiac magnetic resonance imaging (CMR). While these are considered reliable for the evaluation of patients at risk for an iron-overloaded state, there is an access challenge associated with initial and serial CMR scanning in this patient population. Furthermore, there are other limiting factors, such as patient characteristics that may preclude the use of CMR as a viable diagnostic imaging modality for these patients. On the other hand, recent evidence in the literature suggests that transthoracic echocardiography, which has had significant technological advances, can equal or even outperform CMR to identify cardiac functional abnormalities such as subclinical left ventricular strain and left atrial functional abnormalities in iron overload conditions. Therefore, there is a potential role of more frequent use of echocardiography for surveillance of the development of IOC. Our purpose with this narrative review is to describe recent advances in echocardiography and propose a potential increased use of echocardiography in the surveillance of the development of IOC.
铁过载心肌病（IOC）的患病率正在上升。患有依赖输血的贫血症或随着时间的推移铁吸收增加的疾病的患者，存在发生铁过载状态（如 IOC）的重大风险。目前存在针对 IOC 风险患者的诊断评估和随访的指南，由多个部分组成，包括超声心动图、基因检测、肝脏磁共振成像和心脏磁共振成像（CMR）。虽然这些对于评估铁过载状态的患者是可靠的，但在该患者群体中，初始和连续 CMR 扫描存在获取挑战。此外，还有其他限制因素，例如可能排除 CMR 作为这些患者可行的诊断成像方式的患者特征。另一方面，文献中的最新证据表明，经胸超声心动图具有显著的技术进步，可以与 CMR 相媲美，甚至在识别铁过载情况下的心脏功能异常（如亚临床左心室应变和左心房功能异常）方面表现更好。因此，超声心动图在监测 IOC 发展方面的应用具有潜在作用。我们撰写本叙述性综述的目的是描述超声心动图的最新进展，并提出在监测 IOC 发展方面增加超声心动图应用的可能性。
