title: Role of Non-Transferrin-Bound Iron in the pathogenesis of cardiotoxicity in patients with ST-elevation myocardial infarction assessed by Cardiac Magnetic Resonance Imaging.
abstract: BACKGROUND
  Hereditary hemochromatosis, thalassemia and myelodysplastic syndromes represent disease models with evidence of iron-related heart failure. Non-Transferrin Bound Iron (NTBI) induces cardiac toxicity through the production of reactive oxygen species and lipid peroxidation. In ST-elevation acute myocardial infarction (STEMI) with evidence of microvascular obstruction (MVO) and hemorrhage (HEM), HEM may be a source of iron-related cardiac toxicity through NTBI and pro-inflammatory mediators.
  
  
  OBJECTIVE
  The study aims to assess NTBI in patients with STEMI and its possible relationship with MVO and HEM.
  
  
  RESULTS
  NTBI, LPO-Malondialdehyde (MDA) and interleukin-6 (IL-6) were assessed in 15 patients with STEMI immediately before primary percutaneous coronary intervention (PPCI) and at 3, 6, 9, 12, and 24h post-PPCI. Cardiac Magnetic Resonance (CMR) was performed at 5days and 6months after STEMI. Myocardial edema and HEM were assessed by T2 and T2* mapping. MVO and necrotic area were assessed by early and late gadolinium enhancement (LGE). NTBI was detected in 13/15 patients with the highest values in 4 patients with evidence of MVO and HEM. NTBI levels were significantly related to CK-MB and troponin T values. NTBI kinetics appeared to be different in patients with MVO and HEM (7/15 patients), with a peak value at 6h after PCI, in comparison with those with no evidence of MVO and HEM, in whom NTBI values were lower and remained indeterminable after the first 24h.
  
  
  CONCLUSIONS
  The detection of elevated NTBI values in patients with STEMI, MVO and HEM suggests a possible role of iron cardiotoxicity in myocardial damage.
authors.affiliation: CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca'Granda Hospital, Milan, Italy. Electronic address: alberto.roghi@gmail.com.
authors.forename: Alberto
authors.initials: A
authors.lastname: Roghi
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Italy; Department of Medicine and Medical Specialties, Ca'Granda Foundation IRCCS, Ospedale Maggiore, Milan, Italy.
authors.forename: Erika
authors.initials: E
authors.lastname: Poggiali
authors.affiliation: Department of Medicine and Medical Specialties, Ca'Granda Foundation IRCCS, Ospedale Maggiore, Milan, Italy.
authors.forename: Lorena
authors.initials: L
authors.lastname: Duca
authors.affiliation: Cardiology Unit, San Carlo Borromeo Hospital, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Mafrici
authors.affiliation: CMR Unit, Department of Cardiology and Cardiovascular Surgery, Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pedrotti
authors.affiliation: Biochemistry Laboratories, Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Paccagnini
authors.affiliation: Biochemistry Laboratories, Niguarda Ca'Granda Hospital, Milan, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Brenna
authors.affiliation: Cardiovascular Disease Unit, Ca'Granda Foundation IRCCS, Ospedale Maggiore Policlinico, Department of Medicine and Medical Specialties, Milan, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Galli
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, Ca'Granda Foundation IRCCS, Ospedale Maggiore Policlinico, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Italy; Department of Medicine and Medical Specialties, Ca'Granda Foundation IRCCS, Ospedale Maggiore, Milan, Italy.
authors.forename: Maria Domenica
authors.initials: MD
authors.lastname: Cappellini
mesh_terms: D052279:Creatine Kinase, MB Form / Q000378:metabolism; D005260:Female; D006470:Hemorrhage / Q000378:metabolism; D006801:Humans; D015850:Interleukin-6 / Q000378:metabolism; D007501:Iron / Q000097:blood / Q000378:metabolism*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008315:Malondialdehyde / Q000378:metabolism; D008833:Microcirculation / Q000502:physiology; D055806:Microvessels / Q000473:pathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000378:metabolism* / Q000473:pathology / Q000628:therapy; D009205:Myocarditis / Q000378:metabolism / Q000473:pathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D062645:Percutaneous Coronary Intervention; D011446:Prospective Studies; D015427:Reperfusion Injury / Q000503:physiopathology; D061250:Transferrins / Q000097:blood / Q000378:metabolism*; D020107:Troponin T / Q000097:blood / Q000378:metabolism; D020257:Ventricular Remodeling
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D061250:Transferrins; D020107:Troponin T; D008315:Malondialdehyde; D007501:Iron; D052279:Creatine Kinase, MB Form
keywords: Iron; Myocardial infarction; Non-Transferrin Bound Iron; Reperfusion injury