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  • Open Access

Heart T2* for prediction of cardiac complications in well-treated thalassemia major patients

  • 1,
  • 1,
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Journal of Cardiovascular Magnetic Resonance201214 (Suppl 1) :P195

https://doi.org/10.1186/1532-429X-14-S1-P195

  • Published:

Keywords

  • Magnetic Resonance Image
  • Heart Failure
  • Ferritin
  • Pulmonary Hypertension
  • Cardiac Event

Background

T2* Magnetic Resonance Imaging (MRI) technique allows noninvasive quantification of organ-specific iron burden, playing a key role in the management of thalassemia major (TM) patients. There are few data on the incidence of heart failure and arrhythmias in TM patients according to baseline T2* values. So, the aim of this study was to establish prospectively the risk of cardiac complications in a large cohort of well-treated TM patients.

Methods

We considered 527 TM patients (252 males, mean age 30±9) for who clinical data relative to a period of 5 years after the first MRI were collected in a central data base. At time of the first scan mean ferritin levels were1653±1559 ng/l, global heart was 27±13 ms, and excellent/good level of compliance were present in the 96% of the study population.

Results

At 5 years of follow-up, we recorded 24 cardiac events: 4 episodes of cardiac failure, 15 of arrhythmia, 1 of pulmonary hypertension and 4 of other cardiac complications. The majority of these events (21/24) happened within the first 24 months subsequent to the MRI, so we considered this follow-up period.

At the first MRI scan, in patients with cardiac complications the global heart T2* was 22.5 ±12.4 ms. In comparison with global heart T2* values ≥20 ms, there was not a significantly increased risk of cardiac complications associated with global heart T2* values <20 ms (HR= 2.028 P=0.09).

In the heart failure patients the global heart T2* was 19±12 ms. In comparison with global heart T2* values ≥20 ms, there was not a significantly increased risk of heart failure associated with global heart T2* values <20 ms (HR=1.9 P=0.524) or <10 ms (HR=2.6 P=0.443).

In the arrhythmic patients the global heart T2* was 25±13 ms. In comparison with global heart T2* values ≥20 ms, there was not a significantly increased risk of arrhythmia associated with global heart T2* values <20 ms (HR=2.1 P=0.179) or <10 ms (HR=0.8 P=0.824).

During the follow up changes in the chelation therapy (type and/or dose-frequencies) were found in > 25% of the study population.

Conclusions

We detected very few cardiac events, almost all concentrated in the first 24 months. In a large cohort of well-treated TM patients heart T2* lost its power in predicting cardiac events probably due to a patient-specific adjustment of the chelation therapy MRI-guided.

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”.

Figure 1

Authors’ Affiliations

(1)
CMR Unit, Fondazione G.Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, Pisa, Italy
(2)
Epidemiology and Biostatistics Unit, Institute of Clinical Physiology, CNR, Pisa, Italy
(3)
Dipartimento di Radiologia, Ospedale “Sant’Anna”, Ferrara, Italy
(4)
Struttura Complessa di Cardioradiologia-UTIC, P.O. “Giovanni Paolo II”, Lamezia Terme, Italy
(5)
Servizio Talassemia-U.O. Pediatria Talassemia, Az. Osp. "Sant'Antonio abate", Trapani, Italy

Copyright

© Pepe 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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