title: Cardiac and vascular metal deposition with high mortality in nephrogenic systemic fibrosis.
abstract: Nephrogenic systemic fibrosis is a severe disabling disease that can follow gadolinium-based contrast exposure. In this study we analyzed the clinical and laboratory records of patients with nephrogenic systemic fibrosis who had a history of exposure to gadolinium-based contrast media and identified their cardiac and vascular events. At autopsy, we found that the heart, blood vessels, and skin of three patients who died of cardiac and/or vascular complications had appreciable amounts of gadolinium, iron, and aluminum as measured by inductively coupled plasma-mass spectrometry and confirmed by x-ray fluorescence. Of the 32 patients with nephrogenic systemic fibrosis studied, 10 died at a median of 112 days after diagnosis. Cardiovascular events contributed to the mortality of 9 patients and included congestive heart failure, recurrent arrhythmias, hypotension, stroke, limb ischemia, posterior ischemic optic neuropathy and sudden death. Our results show that increased cardiac and vascular complications along with short survival in nephrogenic systemic fibrosis are associated with metal accumulation in the heart, blood vessels, and skin of these patients.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA. sswaminathan@uams.edu
authors.forename: S
authors.initials: S
authors.lastname: Swaminathan
authors.forename: W A
authors.initials: WA
authors.lastname: High
authors.forename: J
authors.initials: J
authors.lastname: Ranville
authors.forename: T D
authors.initials: TD
authors.lastname: Horn
authors.forename: K
authors.initials: K
authors.lastname: Hiatt
authors.forename: M
authors.initials: M
authors.lastname: Thomas
authors.forename: H H
authors.initials: HH
authors.lastname: Brown
authors.forename: S V
authors.initials: SV
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001344:Autopsy; D001808:Blood Vessels / Q000378:metabolism / Q000473:pathology; D002318:Cardiovascular Diseases / Q000139:chemically induced / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D003287:Contrast Media / Q000009:adverse effects* / Q000378:metabolism; D005260:Female; D005355:Fibrosis; D005682:Gadolinium / Q000009:adverse effects* / Q000378:metabolism; D006801:Humans; D007674:Kidney Diseases / Q000150:complications* / Q000378:metabolism / Q000473:pathology*; D008099:Liver / Q000378:metabolism / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D012867:Skin / Q000378:metabolism / Q000473:pathology; D014018:Tissue Distribution
chemical_list: D003287:Contrast Media; D005682:Gadolinium