Pancreatic Functions in Adolescents with Beta Thalassemia Major Could Predict Cardiac and Hepatic Iron Loading: Relation to T2-Star (T2*) Magnetic Resonance Imaging

Abstract

The aim of this study is to assess the correlation between cardiac and hepatic T2* MRI findings with the endocrine and exocrine pancreatic functions in known patients with β-thalassaemia major (β-TM). A total of 50 adolescent patients with β-TM and 44 healthy controls were investigated via: serum amylase, lipase, triglyceride index, oral glucose tolerance test and T2* MRI, to assess iron content in the heart and liver. Diabetes was found in 20%, and 40% of patients had impaired fasting glucose (IFG). Cardiac T2* was less than 10 ms in 22% indicating heavy load with iron in cardiac tissues. There was a significant decrease in median serum amylase (63.5 vs 87.5 IU/L, p=0.003) and lipase (63 vs 90 IU/L, p=0.017) among patients in comparison with the control group. Patients with β-TM and diabetes had lower serum amylase (32 vs 68 IU/L), lipase (28 vs 79 IU/L), cardiac and hepatic T2* MRI (7 vs 25.5 ms; 3 vs 6 ms, p<0.001 for all) than those without diabetes. Similar results were found among patients with IFG when compared with others (p<0.001 for all). Cardiac and hepatic T2* were inversely correlated to triglyceride index (r=-0.376, p=0.014 and r=-0.475, p=0.001, respectively) and positively correlated to amylase (r=0.791 and r=0.790) and lipase (r=0.784 and r=0.783; p<0.001 for all). The endocrine and exocrine pancreatic functions might become an equivalent predictor to cardiac and hepatic iron overload, especially in countries where MRI is not available or where it is expensive. The early occurrence of these abnormalities warrants more intensive chelation therapy.

T2* Mapping to characterize intestinal fibrosis in crohn's disease

“…In the present study, the T2* values decreased with increasing bowel fibrosis in CD. Additionally, the efficacy of the correlation of the T2* values with bowel fibrosis was comparable to that of magnetization transfer imaging that was reported to be effective in assessing fibrosis in CD in an animal model …”

“…T2* values are sensitive to small changes in the biochemical composition, particularly the transformation of water mobility within the macromolecular network, and may reflect the varying phases and statuses of the bowel wall in CD lesions …”

Cardiac Hemosiderosis in Transfusion DependentThalassemia: A Mini-Review

“…39,40 T2* values have also been correlated with levels of pancreases derived digestive enzymes. 16 This observation may indicate a parallel iron deposition patterns for the heart and pancreas. 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.…”

“…15 TDT patients with DM also had significantly lower cardiac T2* value respective to those without this condition indicating a heavier iron load of the heart in presence of DM. 16 These potential relationships are to be more explored in future reports. In addition to acquired factors, genetic variations may also be of importance in iron accumulation within the heart.…”

“…16,[26][27][28] Different indicators have been suggested as predicting factors for the rate of iron deposits within cardiomyocytes in TDT. In following sections, some of the commonly used indicators have been reviewed.…”