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Iron Overload Cardiomyopathy — EECC MCQ

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ModerateCardiomyopathyIron Overload CardiomyopathyEECC

A 30-year-old woman with beta-thalassaemia major on regular transfusions presents with progressive breathlessness. Cardiac MRI T2* mapping shows a myocardial T2* value of 8 ms (normal >20 ms). LVEF is 52%. What does this finding indicate and what is the treatment?

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Correct answer: C — Severe myocardial iron overload requiring intensified chelation therapy; T2* <10 ms is associated with high risk of heart failure and arrhythmias

Cardiac MRI T2* mapping is the gold standard for non-invasive assessment of myocardial iron loading. T2* <20 ms indicates iron overload; <10 ms indicates severe overload with a very high risk of developing heart failure and arrhythmias within 12 months if untreated. This patient's T2* of 8 ms requires urgent intensification of chelation therapy, typically with continuous IV desferrioxamine or combination chelation (desferrioxamine + deferiprone). The LVEF of 52% may still be within normal limits but T2* is a more sensitive early marker than LVEF for iron-mediated cardiac damage. Serial T2* monitoring guides chelation intensity.

Reference: ESC (2023): Guidelines on Cardiomyopathies; NICE Thalassaemia Guidelines