Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia

Merchant, Rashid; Joshi, Aditi; Javed, Ali; Krishnan, Pradeep; Jankharia, Bhavin

doi:10.1007/s13312-011-0115-9

Cited by 23 publications

(23 citation statements)

References 22 publications

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“…In a study by Merchant et al for evaluation of heart iron load by MRI on 60 thalassemia patients in India, similar results were observed. In this study, no cardiac siderosis in 50 %, mild to moderate in 33.3 % and severe cardiac siderosis in 16.7 % were observed [17]. One major factor affecting geographical distribution in heart iron overload is volume of transfused blood and efficacy of iron chelation therapy [10].…”

Section: Discussionmentioning

confidence: 52%

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

Farhangi

Badiei

Moghaddam

et al. 2016

Indian J Hematol Blood Transfus

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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.

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Section: Discussionmentioning

confidence: 52%

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

Farhangi

Badiei

Moghaddam

et al. 2016

Indian J Hematol Blood Transfus

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“…Patients with mild, moderate and severe cardiac iron overload (T2* 12-20, 8-12 and less than 8 ms, respectively) had impaired LVEF in [56] (r 2 = 0.003, P = 0.04) TM/776 patients Retrospective Significant relationship between cardiac R2* and ferritin / Marsella et al [59] (r = -0.359, P < 0.0001) TM/167 patients Prospective Myocardial T2* was correlated with serum ferritin / Tanner et al [60] (r = -0.34, P < 0.001) TM/19 patients, SCD/17 patients Cross sectional Cardiac 1/T2* was correlated with ferritin level / Wood et al [61] (r 2 = 0.33, P = 0.01) TM/106 patients Prospective No significant correlation between heart T2* and serum ferritin × Anderson et al [16] TM/60 patients Prospective Serum ferritin did not correlate with cardiac iron values × Merchant et al [57] TM/20 patients Prospective No correlation between serum ferritin and cardiac T2* × Kolnagou et al [58] TM/47 patients Retrospective Cardiac T2* was not associated with the serum ferritin × Bayraktaroğlu et al [22] TM: Thalassemia major; SCD: Sickle cell disease. TM/776 patients Retrospective Significant correlation between LVEF and cardiac R2* (r = -0.327, P < 0.0001) / Marsella et al [59] TM/106 patients Prospective Significant correlation of myocardial T2* below 20 ms with LVEF (r = 0.61, P < 0.0001), LVESVi (r = 0.50, P < 0.0001), and LV mass index (r = 0.40, P < 0.001) / Anderson et al [16] TM/167 patients Prospective Significant relationship between myocardial iron and LVEF (r = 0.57, P < 0.001) / Tanner et al [60] TM/67 patients Cross sectional Myocardial T2* related to LV diastolic function (EPFR, r = -0.20, P = 0.19; APFR, r = 0.49, P < 0.001; EPFR/APFR ratio, r = -0.62, P < 0.001) / Westwood et al [52] TM/33 patients Cross sectional Good correlation of DT, Tei index and E/Em index with cardiac T2* values (P < 0.05, r = 0.70-0.81) and weak correlation of E/A with T2* (P < 0.05, r = -0.44) / Barzin et al [84] TM/47 patients Retrospective Significant correlations of the myocardial T2* with LVESVi and LVEDVi (r = -0.32, P = 0.027; r = -0.29, P = 0.046, respectively) / Bayraktaroğlu et al [22] TM/19 patients, SCD/17 patients…”

Section: Non-transferrin-bound Ironmentioning

confidence: 97%

“…Several studies indicated that serum ferritin was not correlated with cardiac T2* [16,22,57,58] . However, other studies with larger population size showed a weak relationship between serum ferritin and heart T2* [56,[59][60][61] .…”

Section: Non-transferrin-bound Ironmentioning

confidence: 99%

Early detection of cardiac involvement in thalassemia: From bench to bedside perspective

Koonrungsesomboon

Chattipakorn²,

Fucharoen³

et al. 2013

WJC

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Myocardial siderosis is known as the major cause of death in thalassemia major (TM) patients since it can lead to iron overload cardiomyopathy. Although this condition can be prevented if timely effective intensive chelation is given to patients, the mortality rate of iron overload cardiomyopathy still remains high due to late detection of this condition. Various direct and indirect methods of iron assessment, including serum ferritin level, echocardiogram, non-transferrin-bound iron, cardiac magnetic resonance T2*, heart rate variability, and liver biopsy and myocardial biopsy, have been pro- REVIEW 270August 26, 2013|Volume 5|Issue 8|

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“…Although DFP has good compliance, some serious side effects such as gastrointestinal disturbances, arthropathy, neutropenia and agranulocytosis were reported. However, the combination of DFP and DFO, regarded as “shuttle hypothesis”, was hoped to have a synergistic effect on iron removal and patient compliance [9]. …”

Section: Introductionmentioning

confidence: 99%

Comparative Efficacy and Safety of Deferoxamine, Deferiprone and Deferasirox on Severe Thalassemia: A Meta-Analysis of 16 Randomized Controlled Trials

et al. 2013

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ObjectiveA meta-analysis was conducted to investigate the efficacy and safety of three main iron chelators, namely, deferoxamine (DFO), deferiprone (DFP) and deferasirox (DFX) for thalassemia major (TM) patients. MethodsRandomized controlled trials comparing mono-therapy DFO, DFP, DFX and combined DFP with DFO therapy in TM patients from January 1990 to December 2012 were searched and selected. Two independent authors assessed data from extracted randomized trials for efficacy and safety in the measurements of serum ferritin (SF), live iron concentration (LIC), myocardial iron content (MIC), left ventricular ejection fraction (LVEF) and adverse events (AEs).ResultsSixteen studies were selected. In the comparison of DFP versus DFO treatment groups, a significant difference was revealed on MIC and LVEF (P=0.01 and P=0.007, respectively) but not on SF or LIC level (P=0.65 and P=0.37, respectively). In comparing combined therapy (DFP plus DFO) versus DFO, a significant difference was shown on MIC and LVEF measurements (P<0.00001 and P=0.003, respectively), but not on SF or LIC levels (P=0.93 and P=0.62, respectively). Moreover, the combined DFP with DFO treatment had significantly higher risk than DFO treatment (RR 1.46 with 95%CI 1.04 to 2.04). When comparing DFX with DFO, a significant difference was shown on the SF level (P=0.003), and there was no difference between DFX and DFO in safety evaluation (RR 1.53 with 95%CI 0.31 to 7.49).ConclusionFindings indicated that the most effective and safe iron chelators remains to be proven, and further large-scale, long-term studies are needed.

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Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia

Abstract: Thalassemia patients had significantly higher cardiac iron stores as compared to controls. Serum ferritin and liver iron values did not correlate with cardiac iron values. Three of 10 patients <10 years showed evidence of myocardial siderosis.

Cited by 23 publications

References 22 publications

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

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

Early detection of cardiac involvement in thalassemia: From bench to bedside perspective

Comparative Efficacy and Safety of Deferoxamine, Deferiprone and Deferasirox on Severe Thalassemia: A Meta-Analysis of 16 Randomized Controlled Trials

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