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  • Open Access

Regional myocardial contractility in Thalassemia Major by magnetic resonance tagging

  • 1,
  • 2,
  • 2,
  • 3,
  • 4,
  • 1,
  • 1,
  • 1,
  • 2 and
  • 1
Journal of Cardiovascular Magnetic Resonance201416 (Suppl 1) :P244

https://doi.org/10.1186/1532-429X-16-S1-P244

  • Published:

Keywords

  • Thalassemia
  • Thalassemia Major
  • Cardiac Iron
  • Regional Myocardial Function
  • Thalassemia Major Patient

Background

Magnetic resonance (MR) tagging analyzed by dedicated tracking algorithms allows very precise measurements of myocardial motion and characterization of regional myocardial function. No extensive data are available in literature. Our aim was to quantitatively assess for the regional myocardial contractility in thalassemia major (TM) patients and to correlate it with heart iron overload and global biventricular function.

Methods

Seventy-four TM patients (46 F; 31.8 ± 8.5 yrs) enrolled in the MIOT (Myocardial Iron Overload in Thalassemia) network underwent MR (1.5T). Three short-axis (basal, medial and apical) tagged MR images were analyzed off-line using harmonic phase (HARP) methods (Diagnosoft software) and the circumferential shortening (Ecc) was evaluated for all the 16 myocardial segments. Four main circumferential regions (anterior, septal, inferior, and lateral) were defined. The same axes were acquired by a T2* GRE multiecho technique to assess myocardial iron overload (MIO). Biventricular function parameters were quantitatively evaluated by cine images.

Results

Segmental ECC values ranged from -9.66 ± 4.17% (basal anteroseptal segment) to 13.36 ± 4.57% (mid-anterior segment). No significant circumferential variability was de-tected. Compared with previous studied healthy subjects, TM patients showed strain values sig-nificantly lower in all the circumferential regions at each level (mean difference from 4% to 13%; p < 0.001 for all the comparisons) (see Table 1). Segmental Ecc values were not significantly correlated with the correspondent T2* values and no correlation was detected considering the global values, averaged over all segmental values (see Figure 1). Three groups identified on the basis of cardiac iron distribution: no MIO, heterogenous MIO and homogeneous MIO. The global ECC was comparable among the three groups (-11.56 ± 1.60% vs -11.70 ± 2.43% vs -11.14 ± 1.95%; P = 0.602). Global ECC values were not significantly correlated with age and were comparable between the sexes. Circumferential shortening was not associated to left ventricular (LV) volumes and ejection fraction (with a p > 0.5 in all the comparisons).

Table 1

  

Anterior

Septal

Inferior

Lateral

Basal

Healthy

-0.20 ± 0.03

-0.17 ± 0.03

-0.16 ± 0.03

-0.21 ± 0.03

 

TM

-0.11 ± 0.04

-0.10 ± 0.03

-0.12 ± 0.04

-0.11 ± 0.03

  

Diff = 0.09

p < 0.001

Diff = 0.07

p < 0.001

Diff = 0.04

p < 0.001

Diff = 0.10

p < 0.001

Medium

Healthy

-0.23 ± 0.04

-0.16 ± 0.03

-0.16 ± 0.05

-0.22 ± 0.03

 

TM

-0.14 ± 0.05

-0.12 ± 0.03

-0.11 ± 0.04

-0.12 ± 0.03

  

Diff = 0.09

p < 0.001

Diff = 0.04

p < 0.001

Diff = 0.05

p < 0.001

Diff = 0.10

p < 0.001

Apical

Healthy

-0.24 ± 0.06

-0.18 ± 0.03

-0.23 ± 0.04

-0.24 ± 0.04

 

TM

-0.12 ± 0.04

-0.13 ± 0.04

-0.12 ± 0.05

-0.11 ± 0.04

  

Diff = 0.12

p < 0.001

Diff = 0.05

p < 0.001

Diff = 0.11

p < 0.001

Diff = 0.13

p < 0.001

Figure 1
Figure 1

Comparison with the study by Moore et al involving 31 healthy volunteers.

Conclusions

TM patients showed a significantly lower cardiac contractility compared with healthy subjects, but this altered contractility was not related to cardiac iron, volumes and function.

Funding

The MIOT project receives "no-profit support" from industrial sponsorships (Chiesi and ApoPharma Inc). This study was also supported by: "Ministero della Salute, fondi ex art. 12 D.Lgs. 502/92 e s.m.i., ricerca.

Authors’ Affiliations

(1)
CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana and Institute of Clinical Physiology, Pisa, Italy
(2)
Istituto di Radiologia, Policlinico "Paolo Giaccone", Palermo, Italy
(3)
Centro Trasfusionale, Ospedale S Maria alla Gruccia, Montevarchi, Italy
(4)
Serv. Talassemia, Osp. "V. Emanuele III", Gela, Italy

Copyright

© Meloni et al.; licensee BioMed Central Ltd. 2014

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. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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