MRI assessment of excess cardiac iron in thalassemia major: When to initiate?

Chen, Xiao; Zhang, Zuoquan; Zhong, Jinglian; Yang, Qin; Yu, Taihui; Cheng, Zhigang; Chan, Queenie; Guo, Hua; Liang, Beibei

doi:10.1002/jmri.24781

Cited by 19 publications

(22 citation statements)

References 27 publications

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“…A large cohort of severe LIO patients may only be obtainable in developing countries where TM children may receive inadequate iron chelating therapy and high proportion of them die as teenagers due to the toxicity of iron overload . Our earlier observations have demonstrated that a large scale of TM patients in mainland China suffered from severe iron overload because they did not receive adequate iron chelating therapy. As a result, a lot of patients suffered from HIO at a very young age.…”

Section: Discussionmentioning

confidence: 98%

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Value of severe liver iron overload for assessing heart iron levels in thalassemia major patients

Chen

Zhang

Yang

et al. 2016

Magnetic Resonance Imaging

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Section: Discussionmentioning

confidence: 98%

“…Furthermore, MR can be used to monitor the progress of chelation and adjust the therapy accordingly. For early stage monitoring and therapy, our study has shown that initial heart T2* examination can begin as early as 5 years old …”

mentioning

confidence: 89%

Value of severe liver iron overload for assessing heart iron levels in thalassemia major patients

Chen

Zhang

Yang

et al. 2016

Magnetic Resonance Imaging

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“…It can also accurately predict the development of heart failure and arrhythmias in patients undergoing repeated transfusions [ 67 ]. Some authors advocate its use for the assessment of excess cardiac iron from the early age of 5 years in patients with thalassemia major and suboptimal chelation therapy [ 74 ]. Consequently it is regarded the gold standard for follow-up of iron chelation therapy and therapeutic guidance [ 75 , 76 ].…”

Section: Specific Types Of Restrictive Cardiomyopathymentioning

confidence: 99%

Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment—A Systematic Review

Rammos

Meladinis

Vovas³

et al. 2017

Radiology Research and Practice

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Restrictive cardiomyopathy (RCM) is the least common among cardiomyopathies. It can be idiopathic, familial, or secondary to systematic disorders. Marked increase in left and/or right ventricular filling pressures causes symptoms and signs of congestive heart failure. Electrocardiographic findings are nonspecific and include atrioventricular conduction and QRS complex abnormalities and supraventricular and ventricular arrhythmias. Echocardiography and cardiac magnetic resonance (CMR) play a major role in diagnosis. Echocardiography reveals normal or hypertrophied ventricles, preserved systolic function, marked biatrial enlargement, and impaired diastolic function, often with restrictive filling pattern. CMR offering a higher spatial resolution than echocardiography can provide detailed information about anatomic structures, perfusion, ventricular function, and tissue characterization. CMR with late gadolinium enhancement (LGE) and novel approaches (myocardial mapping) can direct the diagnosis to specific subtypes of RCM, depending on the pattern of scar formation. When noninvasive studies have failed, endomyocardial biopsy is required. Differentiation between RCM and constrictive pericarditis (CP), nowadays by echocardiography, is important since both present as heart failure with normal-sized ventricles and preserved ejection fraction but CP can be treated by means of anti-inflammatory and surgical treatment, while the treatment options of RCM are dictated by the underlying condition. Prognosis is generally poor despite optimal medical treatment.

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“…In fact, there may be a possibility for using T2* values of either pancreas or liver to predict the pace of iron loading in the heart. 41 Such correlations between T2* values of the heart and of the liver has also been reported by Chen et al 24 Left Ventricular Ejection Fraction Relying on LVEF for identifying TDT patients at risk of cardiac failure is highly discouraged. This is because of the adaptation of cardiac function in TDT patients in response to chronic anemia which may overestimate LVEF and therefore neglect an underlying cardiac disorder.…”

Section: Ferritin Levelsmentioning

confidence: 84%

“…Moderate and severe (T2*<10 ms) cardiac iron loading were identified in 42.2% and 21.6% of TDT patients older than 7 years old, respectively. 24 In another study by Borgna-Pignatti et al, a T2* <20 ms was detected in a 6-year-old TDT patient. 25 In this regard, it may be a good practice to perform heart examinations in as early as childhood period in TDT.…”

mentioning

confidence: 86%

Cardiac Hemosiderosis in Transfusion DependentThalassemia: A Mini-Review

Bazi¹,

Keramati²,

Shahramian³

2017

Int J Basic Sci Med

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Iron toxicity within cardiomyocytes is considered as the main pathogenesis of cardiac dysfunction in transfusion dependent thalassemia (TDT). Various methods such as measuring serum ferritin, evaluating cardiac functional and structural parameters by either cardiac magnetic resonance imaging (CMRI) or echocardiography, and monitoring the heart rate variability (HRV) have been proposed to monitor cardiac iron content in patients. High inconsistency is present regarding predictability of various parameters derived by each of these methods in order to predict the cardiac iron overload. The aim of present review was to grasp the most appropriate parameters predicting cardiac hemosiderosis in TDT. Predicating values for cardiac iron deposition of the most in-use indicators such as ferritin, cardiac T2* relaxation time, left ventricular ejection fraction (LVEF), and HRV were discussed. In addition, a description on the most effective preventive measures for cardiac hemosiderosis was provided.

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MRI assessment of excess cardiac iron in thalassemia major: When to initiate?

Abstract: Cardiac iron overload can occur in young TM patients, even as young as 5.5 years old. Assessment of cardiac iron with T2* might need to begin as early as 5 years old if suboptimal chelation therapy is administered.

Cited by 19 publications

References 27 publications

Value of severe liver iron overload for assessing heart iron levels in thalassemia major patients

Value of severe liver iron overload for assessing heart iron levels in thalassemia major patients

Restrictive Cardiomyopathies: The Importance of Noninvasive Cardiac Imaging Modalities in Diagnosis and Treatment—A Systematic Review

Cardiac Hemosiderosis in Transfusion DependentThalassemia: A Mini-Review

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