Effective Method of Evaluating Myocardial Iron Concentration in Pediatric Patients with Thalassemia Major

Overview

Journal J Blood Med

Publisher Dove Medical Press

Specialty Hematology

Date 2019 Aug 3

PMID 31372080

Citations 4

Authors

Arwa Khaled

Dina A Ezzat

Hoda A Salem

Hadeel M Seif

Hoda Rabee

Affiliations

Soon will be listed here.

Abstract

Background: The use of T2* magnetic resonance imaging (MRI) has been promoted by recent studies as a noninvasive method for the detection of iron overload in thalassemia major patients. This study aims to estimate the iron load in the heart and liver of thalassemia major patients using T2* MRI and to determine its correlation with the left ventricle ejection fraction and serum ferritin level.

Methods: Forty β-Thalassemia major patients were included in the study. We evaluated the serum ferritin level, echocardiography, cardiac T2*, myocardial iron concentration (MIC), liver iron concentration (LIC) and hepatic T2* in all patients. CMR T2* findings were categorized as normal cardiac T2* (T2* >20 ms) or abnormal cardiac T2* (T2* <20 ms).

Results: The study found that 85% of patients had a normal cardiac T2* value. The median serum ferritin level was 2189. A significant inverse correlation was found between the serum ferritin level and the cardiac T2* (r=-0.381, =0.015); however, the correlations between serum ferritin and the hepatic T2* and liver iron concentration were statistically non-significant (=0.539 and =0.637, respectively). Additionally, the LVEF correlation was statistically non-significant with SF, hepatic T2* and cardiac T2*.

Conclusion: Regardless of the serum ferritin level or left ventricle function, a cardiac T2* MRI should be done for all patients with β-Thalassemia major in order to estimate the myocardial iron concentration.

Citing Articles

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References

Anderson L, Holden S, Davis B, Prescott E, Charrier C, Bunce N . Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J. 2002; 22(23):2171-9. DOI: 10.1053/euhj.2001.2822. View

Engle M, Erlandson M, Smith C . LATE CARDIAC COMPLICATIONS OF CHRONIC, SEVERE, REFRACTORY ANEMIA WITH HEMOCHROMATOSIS. Circulation. 1964; 30:698-705. DOI: 10.1161/01.cir.30.5.698. View

Wood J, Michael Tyszka J, Carson S, Nelson M, Coates T . Myocardial iron loading in transfusion-dependent thalassemia and sickle cell disease. Blood. 2003; 103(5):1934-6. DOI: 10.1182/blood-2003-06-1919. View

Voskaridou E, Douskou M, Terpos E, Papassotiriou I, Stamoulakatou A, Ourailidis A . Magnetic resonance imaging in the evaluation of iron overload in patients with beta thalassaemia and sickle cell disease. Br J Haematol. 2004; 126(5):736-42. DOI: 10.1111/j.1365-2141.2004.05104.x. View

Anderson L, Westwood M, Holden S, Davis B, Prescott E, Wonke B . Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2* cardiovascular magnetic resonance. Br J Haematol. 2004; 127(3):348-55. DOI: 10.1111/j.1365-2141.2004.05202.x. View

Mavrogeni S, Markussis V, Kaklamanis L, Tsiapras D, Paraskevaidis I, Karavolias G . A comparison of magnetic resonance imaging and cardiac biopsy in the evaluation of heart iron overload in patients with beta-thalassemia major. Eur J Haematol. 2005; 75(3):241-7. DOI: 10.1111/j.1600-0609.2005.00474.x. View

Ghugre N, Enriquez C, Coates T, Nelson Jr M, Wood J . Improved R2* measurements in myocardial iron overload. J Magn Reson Imaging. 2005; 23(1):9-16. PMC: 2892961. DOI: 10.1002/jmri.20467. View

Wood J, Enriquez C, Ghugre N, Otto-Duessel M, Aguilar M, Nelson M . Physiology and pathophysiology of iron cardiomyopathy in thalassemia. Ann N Y Acad Sci. 2005; 1054:386-95. PMC: 2892916. DOI: 10.1196/annals.1345.047. View

Tanner M, Galanello R, Dessi C, Westwood M, Smith G, Nair S . Myocardial iron loading in patients with thalassemia major on deferoxamine chelation. J Cardiovasc Magn Reson. 2006; 8(3):543-7. DOI: 10.1080/10976640600698155. View

10.

Aessopos A, Fragodimitri C, Karabatsos F, Hatziliami A, Yousef J, Giakoumis A . Cardiac magnetic resonance imaging R2* assessments and analysis of historical parameters in patients with transfusion-dependent thalassemia. Haematologica. 2007; 92(1):131-2. DOI: 10.3324/haematol.10455. View

11.

Noetzli L, Carson S, Nord A, Coates T, Wood J . Longitudinal analysis of heart and liver iron in thalassemia major. Blood. 2008; 112(7):2973-8. PMC: 2556627. DOI: 10.1182/blood-2008-04-148767. View

12.

He T, Gatehouse P, Smith G, Mohiaddin R, Pennell D, Firmin D . Myocardial T2* measurements in iron-overloaded thalassemia: An in vivo study to investigate optimal methods of quantification. Magn Reson Med. 2008; 60(5):1082-9. PMC: 2593631. DOI: 10.1002/mrm.21744. View

13.

Walker J, Nair S . Detection of the cardiovascular complications of thalassemia by echocardiography. Ann N Y Acad Sci. 2010; 1202:165-72. DOI: 10.1111/j.1749-6632.2010.05643.x. View

14.

Gujja P, Rosing D, Tripodi D, Shizukuda Y . Iron overload cardiomyopathy: better understanding of an increasing disorder. J Am Coll Cardiol. 2010; 56(13):1001-12. PMC: 2947953. DOI: 10.1016/j.jacc.2010.03.083. View

15.

Marsella M, Borgna-Pignatti C, Meloni A, Caldarelli V, Dellamico M, Spasiano A . Cardiac iron and cardiac disease in males and females with transfusion-dependent thalassemia major: a T2* magnetic resonance imaging study. Haematologica. 2011; 96(4):515-20. PMC: 3069227. DOI: 10.3324/haematol.2010.025510. View

16.

Carpenter J, He T, Kirk P, Roughton M, Anderson L, de Noronha S . On T2* magnetic resonance and cardiac iron. Circulation. 2011; 123(14):1519-28. PMC: 3435874. DOI: 10.1161/CIRCULATIONAHA.110.007641. View

17.

Bayraktaroglu S, Aydinok Y, Yildiz D, Uluer H, Savas R, Alper H . The relationship between the myocardial T2* value and left ventricular volumetric and functional parameters in thalassemia major patients. Diagn Interv Radiol. 2011; 17(4):346-51. DOI: 10.4261/1305-3825.DIR.3933-10.2. View

18.

Youssef D, Mohammad F, Ahmed Fathy A, Aly Abdelbasset M . Assessment of hepatic and pancreatic iron overload in pediatric Beta-thalassemic major patients by t2* weighted gradient echo magnetic resonance imaging. ISRN Hematol. 2013; 2013:496985. PMC: 3625578. DOI: 10.1155/2013/496985. View

19.

Pennell D, Udelson J, Arai A, Bozkurt B, Cohen A, Galanello R . Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation. 2013; 128(3):281-308. DOI: 10.1161/CIR.0b013e31829b2be6. View

20.

Yang G, Liu R, Peng P, Long L, Zhang X, Yang W . How early can myocardial iron overload occur in beta thalassemia major?. PLoS One. 2014; 9(1):e85379. PMC: 3899006. DOI: 10.1371/journal.pone.0085379. View