Rapid Onset of Iron Overload Cardiomyopathy in Cirrhosis.

Iron overload cardiomyopathy (IOC) is a rare cause of heart failure classically associated with hereditary or transfusion-related hemochromatosis. Although iron accumulation occurs in cirrhosis, the development and clinical course of IOC in this population remain poorly described. We report 2 patients with cirrhosis who developed IOC without hereditary hemochromatosis or transfusion-dependent anemia. Patient #1 was a 54-year-old man with alcohol-associated cirrhosis who developed severe cardiomyopathy (left ventricular ejection fraction 23%, 55% 1 year earlier). Patient #2 was a 56-year-old man with cryptogenic cirrhosis who presented with new cardiomyopathy (left ventricular ejection fraction 38%, 71% 9 months earlier). Both patients had elevated ferritin and transferrin saturation, along with reduced myocardial T2∗ relaxation time on cardiac magnetic resonance imaging, consistent with IOC. Both received iron chelation therapy; one patient died, and the other is awaiting combined heart-liver transplantation. These cases highlight IOC as an important consideration in patients with cirrhosis presenting with new cardiomyopathy.