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  • Moderated poster presentation
  • Open Access

Different patterns of myocardial iron overload by T2* Cardiovascular MR as markers of risk for cardiac complication in thalassemia major

  • 1,
  • 1,
  • 1,
  • 1,
  • 2,
  • 3,
  • 4,
  • 5,
  • 1 and
  • 1
Journal of Cardiovascular Magnetic Resonance201214 (Suppl 1) :M1

https://doi.org/10.1186/1532-429X-14-S1-M1

  • Published:

Keywords

  • Heart Failure
  • Left Ventricle
  • Cardiomyopathy
  • Pulmonary Hypertension
  • Cardiovascular Magnetic Resonance

Background

Cardiac complications mainly related to myocardial iron overload (MIO) remain the main cause of morbidity and mortality in thalassemia major (TM). Thalassemia cardiomyopathy is treatable and partly reversible if appropriate chelation therapy is instituted in time. The validated multislice multiecho T2* Cardiovascular Magnetic Resonance (CMR) technique has permitted to quantify segmental and global myocardial iron burden detecting different patterns of iron overload. Aim of our study was to verify the risk of cardiac complications related to different patterns of MIO in a large cohort of TM patients.

Methods

We considered 812 TM patients for who CMR and cardiac data were collected in a central data base. Three short-axis views (basal, medium, apical) of the left ventricle were acquired using a multislice multiecho T2* sequence. Using a previously validated software the 16 segmental T2* values and the mean global heart T2* value were provided. A conservative cut off of 20 ms was considered the limit of normal for the segmental and global T2* values.

Results

We identified 4 groups of patients: group I (17%) with homogeneous MIO (all segments with T2*<20 ms), group II (12%) with heterogeneous MIO (some segments with T2*<20 ms and others with T2*≥20 ms) and global heart T2*<20 ms; group III (29%) with heterogeneous MIO and global heart T2*≥20 ms; group IV (42%) with no MIO (all segments with T2*≥20 ms). The percentage of patients with cardiac complications was significantly different in the 4 groups (group I 24.6%, group II 20.6%, group III 8.4%; group IV 16.4%; P<0.0001). In particular, the percentage of patients with heart failure was significantly different in the 4 groups (group I 17.4%, group II 16.5%, group III 4.2%, group IV 8.3%; P<0.0001). No significant differences were found among groups in the percentage of arrhythmias and pulmonary hypertension. Odds Ratio for cardiac complications was 1.7 (1.0-2.7 OR 95% CI; P=.041) for patients with homogeneous MIO vs patients with no MIO. Odds Ratio for heart failure was 2.3 (1.3-4.2 OR 95% CI; P=0.004) for patients with homogeneous MIO versus patients with no MIO and 2.2 (1.1-4.2 OR 95% CI; P=.020) for patients with heterogeneous MIO and global heart T2*<20 ms versus patients with no MIO.

Conclusions

Homogeneous MIO predicts a significantly higher risk to develop cardiac complications, especially heart failure, suggesting an intensive chelation therapy in this group of patients.

Funding

“No-profit” support by industrial sponsorships (Chiesi, Apotex and GE Healtcare) and “Ministero della Salute, fondi ex art. 12 D.Lgs. 502/92 e s.m.i., ricerca sanitaria finalizzata anno 2006” e “Fondazione L. Giambrone”.

Table 1

 

Homogeneous MIO (N=138)

Heterogeneous MIO and global Heart T2* < 20 ms (N=97)

Heterogeneous MIO and global Heart T2* ≥ 20 ms (N=238)

No MIO (N=339)

P-value

Sex (M/F)

67/71

38/59

119/119

157/172

0.304

Age (years)

28.9 ± 7.4

30.8 ± 7.4

30.4 ± 8.9

31.1 ± 8.9

0.069

Hb pre-transfusion (g/dl)

9.7 ± 0.6

9.6 ± 0.5

9.7 ± 0.6

9.6 ± 0.8

0.309

Ferritin levels (ng/l)

2454 ± 1969

2043 ± 1796

1328 ± 1277

1114 ± 1004

<0.0001

Cardiac disease, n (%)

34 (24.6%)

20 (20.6%)

20 (8.4%)

56 (16.5%)

<0.0001

Heart failure, n (%)

24 (17.4%)

16 (16.5%)

10 (4.2%)

28 (8.3%)

<0.0001

Arrhythmias, n (%)

13 (9.4%)

6 (6.2%)

8 (3.4%)

23 (6.8%)

0.112

Pulmonary hypertension, n (%)

3 (2.2%)

1 (1.0%)

4 (1.7%)

14 (4.1%)

0.192

Authors’ Affiliations

(1)
CMR Unit, Fondazione G.Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, Pisa, Italy
(2)
Struttura Complessa di Cardioradiologia-UTIC, P.O. “Giovanni Paolo II”, Lamezia Terme, Italy
(3)
Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-Lancisi-Salesi", Ancona, Italy
(4)
Centro trasfusionale e di microcitemia, Ospedale civile, Olbia, Italy
(5)
Servizio Regionale Talassemie, Policlinico, Bari, Italy

Copyright

© Meloni et al; licensee BioMed Central Ltd. 2012

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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