Liver and heart T2* measurement in secondary hemochromatosis

Portillo, Manuel; Uranga, M.; Echeverría, J.M. Alústiza; Wells, C. Gervás; Iñiguez, Astudillo

doi:10.1016/j.rxeng.2011.08.002

Cited by 5 publications

(5 citation statements)

References 30 publications

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“…Due to a continuous equilibration between these 3 forms, this technique accurately predicts myocardial iron content. 90 in a recent study by Barrera et al, 91 no association was observed between the myocardial t2* values and ferritin in the blood, the liver iron concentration, or the liver t2* value. Pepe et al 92 in their study using multislice multiGe t2* technique to analyze lv myocardial iron content observed a good correlation between the global t2* (12 segments) and t2* value in midventricular t2*septum, concluding that midventricular t2* is a good marker of the entire myocardial iron content.…”

Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 80%

Cardiac Involvement in Hemochromatosis

Gulati

Harikrishnan

Palaniswamy

et al. 2014

Cardiology in Review

123

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Cardiac hemochromatosis or primary iron-overload cardiomyopathy is an important and potentially preventable cause of heart failure. This is initially characterized by diastolic dysfunction and arrhythmias and in later stages by dilated cardiomyopathy. Diagnosis of iron overload is established by elevated transferrin saturation (>55%) and elevated serum ferritin (>300 ng/mL). Genetic testing for mutations in the HFE (high iron) gene and other proteins, such as hemojuvelin, transferrin receptor, and ferroportin, should be performed if secondary causes of iron overload are ruled out. Patients should undergo comprehensive 2D and Doppler echocardiography to evaluate their systolic and diastolic function. Newer modalities like strain imaging and speckle-tracking echocardiography hold promise for earlier detection of cardiac involvement. Cardiac magnetic resonance imaging with measurement of T2* relaxation times can help quantify myocardial iron overload. In addition to its value in diagnosis of cardiac iron overload, response to iron reduction therapy can be assessed by serial imaging. Therapeutic phlebotomy and iron chelation are the cornerstones of therapy. The average survival is less than a year in untreated patients with severe cardiac impairment. However, if treated early and aggressively, the survival rate approaches that of the regular heart failure population.

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Section: Cardiac Magnetic Resonance Imagingmentioning

confidence: 80%

Cardiac Involvement in Hemochromatosis

Gulati

Harikrishnan

Palaniswamy

et al. 2014

Cardiology in Review

123

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“…No significant difference was found between the four groups created according to the severity of liver IO (p = .083), whereas the combined severe and moderate groups had significantly higher PFL than the combined mild and normal groups did (p = .040). Studies conducted by Elfawal et al, 16 Barrera Portilla et al, 17 and Fahmy et al 18 showed that there was a significant relationship between the PFL and liver IO. The current study results were observed to be compatible with those findings.…”

Section: Discussionmentioning

confidence: 95%

Interrelationship between liver T2*‐weighted magnetic resonance imaging and acoustic radiation force impulse elastography measurement results and plasma ferritin levels in children with β‐thalassemia major

Kaban

Damar

2021

J of Clinical Ultrasound

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Purpose: To evaluate correlation and agreement between T2*-weighted magnetic resonance imaging (T2*-wMRI), acoustic radiation force impulse elastography (ARFIe) measurement results of liver and plasma ferritin levels (PFLs) in children with β-thalassemia major (β-TM). Methods:The study included 40 pediatric patients (aged 64-216 months; 14 girls, 26 boys) receiving blood transfusion and chelation therapy. To detect the severity of liver iron overload (LIO) and concomitant parenchymal fibrosis, T2*-wMRI and ARFI-e measurements were performed from the right lobe segments. Student's ttest, Mann-Whitney U, ANOVA, Spearman's test and ICC were used for statistical analysis.Results: After the measurements of T2*-wMRI, patients were grouped as normal in 4 (10%), mild in 11 (27.5%), moderate in 21 (52.5%), and severe in 4 (10%) cases in terms of LIO. Combined moderate and severe groups had significantly higher ARFI-e and PFL values than the combination of other groups (p = .001, p = .040). The ARFIe measurements of boys were found to be significantly higher than those of girls (p = .023). A strong negative correlation between T2*-wMRI and ARFI-e and a moderate negative correlation between T2*-wMRI and PFL were detected (p;r = 0.001;-0.606, p;r = 0.009; À0.407). A strong positive correlation was found between ARFI-e values and PFL (p;r = 0.001; 0.659). The optimal cut-off value of ARFI-e to predict liver fibrosis because of moderate&severe LIO was determined to be 1.29 M/s (80% sensitivity and 88% specificity). A moderate agreement was observed between the T2*-wMRI and ARFI-e methods [ICC: 0.680, 95% CI: (0.470 to 0.817)]. Conclusion:Given the strong correlation and moderate agreement between ARFI-e and T2*-wMRI, ARFI -e could be used to monitor LIO in children with β-TM.

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“…This result is relevant with existing literature. Several other studies found poor or even lack of any correlation between liver and cardiac iron content including studies by Merchant et al (21) on 60, Barrera Portilla et al (9) on 16, Wood et al (20) on 77 and Elfawal (29) on 80 thalasemia patients. This is mainly due to the different iron accumulation and elimination mechanisms of the heart and the liver.…”

Section: Figure 4 the Correlation Graphic Between Liver T2* (Ms) And Serum Ferritin Levels (Ng/dl)mentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

“…Therefore, early detection of the presence and extent of iron accumulation in these patients is crucial (4)(5)(6)9) . Indirect serum markers used in the followup of iron overloading, such as measurements of serum ferritin may be inadequate and have a restricted predictive value to evaluate the disease process (9)(10)(11) . Also, being an acute phase reactant, serum ferritin levels may be elevated in different clinical conditions like infections, inflammatory processes, liver failure or malignant diseases (12) .…”

Section: Introductionmentioning

confidence: 99%

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MR T2* Evaluation of the Hepatic and Myocardial Iron Deposition in Thalasemia Major Patients and the Correlation of the Results with Serum Ferritin Levels and Cardiac Functions

Oncel¹,

Çakır²,

Öncel³

2020

BUCH

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INTRODUCTION: The purpose of this study was to evaluate the correlation between myocardial iron deposition and cardiac functions along with the correlations between myocardial iron deposition, hepatic iron deposition and serum ferritin levels in beta thalasemia major patients. METHODS: 145 beta thalasemia major patients (85 males and 60 females age between 9-53 years) between March 2016 and September 2018 and were retrospectively evaluated. T2* calculations were done for the heart and the liver. For functional evaluation of the heart, left ventricular ejection fraction calculation and wall motion analysis were done. The serum ferritin levels between 20-250 ng/ml were accepted as normal. The correlation between myocardial iron deposition and cardiac functions as well as the correlations between myocardial iron deposition, hepatic iron deposition and serum ferritin levels were statistically evaluated. RESULTS: The statistical analysis revealed a significant correlation between cardiac functional abnormalities and the severity of myocardial iron deposition. A statistically significant correlation was also found between myocardial iron deposition and serum ferritin levels in regard of both the presence and severity. Similarly, hepatic iron deposition and serum ferritin levels were found to be correlated. On the other hand, no statistically significant correlation was detected between hepatic and cardiac iron accumulations. DISCUSSION AND CONCLUSION: MRI is an accurate tool to quantatively evaluate hepatic and myocardial iron deposition in thalasemia major patients. The periodical follow up of patients with MRI examinations for hepatic and myocardial iron deposition in addition to serum ferritin levels may help to modify the treatment in patients with transfusion dependent anemias.

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Liver and heart T2* measurement in secondary hemochromatosis

Cited by 5 publications

References 30 publications

Cardiac Involvement in Hemochromatosis

Cardiac Involvement in Hemochromatosis

Interrelationship between liver T2*‐weighted magnetic resonance imaging and acoustic radiation force impulse elastography measurement results and plasma ferritin levels in children with β‐thalassemia major

MR T2* Evaluation of the Hepatic and Myocardial Iron Deposition in Thalasemia Major Patients and the Correlation of the Results with Serum Ferritin Levels and Cardiac Functions

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