{"doi":"10.1002/jha2.662","title":"Effect of standard phlebotomy on myocardial and hepatic iron levels in newly diagnosed cardiac asymptomatic hereditary hemochromatosis subjects with C282Y homozygosity","abstract":"Standard phlebotomy effectively reduces systemic and tissue iron overload (IO) in hemochromatosis patients [1-3]. However, the long-term therapeutic effect of phlebotomy on tissue IO in newly diagnosed cardiac asymptomatic hereditary hemochromatosis (HH) subjects during the course of standard therapy in a prospective cohort is not described. Up to now, only one cohort study examined changes in myocardial iron levels after phlebotomy therapy in newly diagnosed HH subjects as far as we know [4]. The study showed myocardial iron levels did not change significantly after 3 months of the standard therapy in the newly diagnosed HH subjects; however, it lacked longer term follow-up, was limited to myocardial iron, and had no control subjects. Therefore, we have examined the effect of standard phlebotomy therapy on myocardial and hepatic iron content measured with T2* (T2 star magnetic vector decay constant) derived from noninvasive magnetic resonance imaging (MRI) in our cohort of cardiac asymptomatic HH subjects (n = 22) with C282Y homozygosity as well as in age-gender matched normal volunteers (NV, n = 21) who lacked the HFE mutation to cause HH over a 5-year follow-up in the National, Heart, Lung, and Blood Institute (NHLBI)-sponsored “Heart Study of Hemochromatosis” (ClinicalTrials.gov number, NCT00068159) [5-7]. The study was approved by the Institutional Review Board of the NHLBI of the National Institutes of Health (NIH) and was performed in accordance with the ethical standards as laid down in the Declaration of Helsinki and its later amendments or comparable ethical standards [8]. Consent for the study was obtained from the participants. The demographic data of these groups were published in our previous articles [5, 7]. The average age of the newly diagnosed HH group was 48 ± 11 years (data are mean ± SD, 27% female) and that of the NV group was 48 ± 8 years at baseline (33% female). They showed no significant left ventricular systolic dysfunction as compared to NV subjects [5, 7]. The research nurses for this study communicated with the HH subjects throughout the study period to ensure the maintenance of the standard phlebotomy therapy by their local clinical care providers. Myocardial and liver T2* values and blood test results were obtained from the clinical information system of the NIH Clinical Center. T2* of myocardium and liver was measured from the images obtained with a 1.5 T MRI scanner using a gradient echo sequence [9, 10]. Smaller T2* measurements represent higher tissue iron level. MRIs were performed at baseline, 6-month, and 5-year follow-ups in HH subjects and baseline and 5-year follow-up in NV subjects. For data analysis, the normality test of each parameter was conducted with the Shapiro-Wilk test. If the normality of the data was established, an unpaired t-test was used to compare the HH and NV groups at each time point and to compare measurements between baseline and 5-year follow-up in the NV group. ANOVA with post hoc Tukey-Kramer HSD tests was used to compare different time points in the HH group. If the normality of the data was not established, nonparametric statistical methods were used instead. The Wilcoxon test was used instead of the unpaired t-test, and Kruskal–Wallis test with post hoc Wilcoxon tests was used instead of ANOVA with post hoc Tukey-Kramer HSD tests to analyze the data whose normality were not established. The χ-square test was used to compare the frequency of female sex between the groups and time points in the same group. p-Values less than 0.05 were considered to be statistically significant. At baseline, 20 HH and 20 NV subjects had MRI and both myocardial and hepatic T2* could be obtained in 17 HH subjects and 20 NV subjects. At 6-month follow-up, 17 HH subjects had MRI with evaluable T2* in all cases. At 5-year follow-up, 12 HH and 18 NV subjects had MRI with evaluable T2* in all cases. Among newly diagnosed HH subjects whose tissue T2*were evaluable, the measures of syste","journal":"eJHaem","year":2023,"id":368881,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.958,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":328468,"name":"W. Patricia Bandettini","orcid":"0000-0003-2342-5637","position":1,"is_corresponding":false},{"id":290485,"name":"Douglas R. Rosing","orcid":null,"position":2,"is_corresponding":false},{"id":1127239,"name":"Yukitaka Shizukuda","orcid":"0000-0001-9850-0385","position":0,"is_corresponding":true}],"reference_count":18,"raw_metadata":null,"created_at":"2026-07-19T01:15:24.517012Z","pmid":"37206277","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}