Assessment of Heart and Liver Iron Overload in Thalassemia Major Patients Using T2* Magnetic Resonance Imaging

Abstract

Accumulation of excess iron in heart can lead to cardiac dysfunction, which is the most common cause of death in thalassemia major patients. Biopsy is an invasive procedure and therefore not an ideal option to assess iron load. However, standard/usual non-invasive methods, such as ferritin measurement, have some limitations and the results show poor correlations with iron load. Magnetic Response Imaging (MRI-T2*), as a non-invasive and reliable method for iron load assessment in organs such as liver and heart, can be suggested as a favorable alternative. This cross-sectional study was implemented in Thalassemia and Hemophilia Clinic Center (Sarvar) affiliated with Mashhad University of Medical Sciences, Mashhad, Iran, from 2012 to 2013. After the approval of the research protocol by the local ethic committee, laboratory tests, including CBC and serum ferritin, were carried out, and echocardiography and heart and liver MRI-T2* were performed. All statistical analysis was done through SPSS software (version 11.5), using independent sample test and Pearson's correlation coefficient test. A value ≤0.05 was considered to be significant. 88 patients with the mean (±SD) age of 21.2 (±5.6) years, (range 11-37 years) were observed. Iron load was assessed using MRI-T2* with the following results: Out of 88 patients, 48.9 % had mild to severe cardiac siderosis, and 75.2 % had mild to severe liver siderosis. We demonstrated a correlation between liver MRI-T2* and serum ferritin, and heart MRI-T2* and ejection fraction. However, no correlation between liver and heart MRI-T2* was observed. Heart and liver siderosis is a common and serious problem in thalassemia major patients, and MRI-T2* as a sensitive and non-invasive technique can be used for early/timely detection of siderosis and good therapeutic monitoring in these patients.

Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload

“…Our results demonstrated a significant correlation between liver and heart iron load assessed by MRI-T2*, while this correlation was lost at follow-up. These contradictory findings are consistent with previous reports [33,34]. These results could be attributed to differences in iron transport and deposition in these organs [33].…”

Role of Cardiovascular Magnetic Resonance Imaging in Assessment of Myocardial Iron Overload in Thalassemia Patients

“…And with Wahidiyat et al (18) study that showed the magnitude of liver iron overload does not correlate with myocardial iron. In other studies, like Merchant et al (19) and Farhangi et al (21) studies no correlation was found between liver and heart iron load.…”

Iron deposition in autopsied liver specimens from older patients receiving intravenous iron infusion

“…Even ageing anaemic patients with adequate ferritin levels, but in a state of chronic inflammation, may be inadvertently administered iron [16]. It is unclear whether the amount of iron administered is appropriate, but there are several reports of iron overload using MRI and liver fibrosis markers in cases of thalassemia [17,18]. Furthermore, in hepatitis C cases, associations of iron overload in liver biopsies have also been investigated [17].…”