Iron overload cardiomyopathy

Last revised by Arlene Campos on 10 Jun 2024

Iron overload cardiomyopathy (IOC) refers to a secondary form of cardiomyopathy resulting from the accumulation of iron in the myocardium. It occurs mainly due to genetically determined disorders of iron metabolism (e.g. cardiomyopathy in hemochromatosis, thalassemia 6,7) or multiple transfusions.


It been mostly described as a dilated cardiomyopathy, characterized by:

In primary hemochromatosis leading to iron overload, the cardiomyopathy is classically categorized as an infiltrative cause of restrictive cardiomyopathy. While in those with secondary hemochromatosis, there may be severe diastolic LV dysfunction in the early stages of the disease, before LVEF is affected 3.

Radiographic features

Cardiac MRI

CMR-derived T2* relaxation time is the mainstay for the quantitative assessment of cardiac iron deposition.

Measured in a full-thickness area of interest in the interventricular septum, T2* is highly representative of global myocardial iron.

A value of 20 ms is considered to be the threshold for myocardial siderosis.

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