Role of CMR feature-tracking derived left ventricular strain in predicting myocardial iron overload and assessing myocardial contractile dysfunction in patients with thalassemia major

Ojha, Vineeta; Ganga, Kartik P.; Seth, Tulika; Roy, Ambuj; Naik, Nitish; Jagia, Priya; Gulati, Gurpreet Singh; Kumar, Sanjeev; Sharma, Sanjiv

doi:10.1007/s00330-020-07599-7

Cited by 16 publications

(11 citation statements)

References 50 publications

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“…One possible explanation for the divergence in results is that although 70% in the preceding study had MIO, 48.36% had MIO in our study [ 21 ]. As comparable observations have previously been documented [ 7 , 22 ], the variance in LVGRS values between groups deserves more explanation. This demonstrates that while MIO is essential, it may not be sufficient to cause global or segmental left ventricular failure.…”

Section: Discussionsupporting

confidence: 84%

“…This demonstrates that while MIO is essential, it may not be sufficient to cause global or segmental left ventricular failure. Impairment of LVEF in these patients may occur from the combination of a number of previously described variables [ 7 , 22 ]. In addition to MIO, they have demonstrated that an immune-inflammatory pathway plays a substantial role in causing left ventricular failure in these individuals.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to MIO, they have demonstrated that an immune-inflammatory pathway plays a substantial role in causing left ventricular failure in these individuals. Consequently, the strain values (which represent the LV function) and the T2* values (which reflect the MIO function) might not have a linear relationship [ 7 , 22 ]. Two recent studies examining the predictive value of LVGLS in patients with preserved EF found it to be favorable in the majority of cases.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have touted cardiac magnetic resonance feature tracking (CMR-FT) as a game-changing, high-resolution technique for measuring left and right ventricular myocardial deformation [ 5 , 6 ]. Recent CMR research revealed a significant correlation between CMR-FT and T2*-weighted imaging (T2*) and their ability to detect contractile abnormalities in thalassemia patients with normal LVEF [ 7 ]. When comparing MIO patients with preserved EF to those without, the left ventricle strain was significantly lower in those with preserved EF, but not much is known about how myocardial iron overload cardiomyopathy affects the right ventricle (RV) in people with thalassemia.…”

Section: Introductionmentioning

confidence: 99%

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Significance of Cardiac Magnetic Resonance Feature Tracking of the Right Ventricle in Predicting Subclinical Dysfunction in Patients with Thalassemia Major

et al. 2022

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In patients with thalassemia major (TM), cardiac magnetic resonance feature-tracking (CMR-FT) has been shown to be an effective method for diagnosing subclinical left ventricular (LV) dysfunction. This study aimed to determine whether CMR-FT could detect abnormal RV dysfunction in patients with a normal right ventricular ejection fraction (RVEF). We performed a retrospective analysis of TM patients admitted to Dubai’s Rashid Hospital between July 2019 and March 2021. The inclusion criteria were TM patients with SSFP cine with T2* (T2*-weighted imaging), while exclusion criteria included any other cardiovascular disease. When there was no myocardial iron overload (MIO) (T2* ≥ 20 ms) and when there was significant MIO (T2* < 20 ms), the CMR-FT was used to correlate with EF. Among the 89 participants, there were 46 men (51.7%) and 43 women (48.3%), with a mean age of 26.14 ± 7.4 years (range from 10 to 48 years). Forty-six patients (51.69%) did not have MIO, while 43 individuals did (48.31%). Thirty-nine patients (32.6%) were diagnosed with severe MIO, while seventeen (19.1%) were diagnosed with mild to moderate MIO. A significant correlation existed between RVEF and T2* values (r = 0.274, p = 0.014) and between left ventricular ejection fraction (LVEF) and T2* values (r = 0.256, p = 0.022). Using a multiple logistic regression model with predictors such as right ventricular longitudinal strain (RVGLS), LV ejection fraction (LV EF), and hemoglobin, abnormal myocardial iron overload can be predicted. This model demonstrates an AUC of 78.3%, a sensitivity of 72%, and a specificity of 76%. In the group with preserved RVEF > 53%, the left ventricular radial strain (LVGRS) (p = 0.001), right ventricular radial strain (RVGRS) (p = 0.000), and right ventricular basal circumferential strain (RVGCS-basal) (p = 0.000) CMR-FT strain values are significantly lower than those of the control group (p > 0.05). There was no significant correlation between the LVGLS and T2*. RVGLS was ranked among the most accurate predictors of abnormal myocardial iron overload. The LVGRS, RVGRS, and RVGCS-basal CMR-FT strain values were the best predictors of subclinical RV dysfunction in the group with preserved RVEF. The most accurate way to diagnose MIO is still T2*, but FT-strain can help us figure out how MIO affects the myocardium from a pathophysiological point of view.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Significance of Cardiac Magnetic Resonance Feature Tracking of the Right Ventricle in Predicting Subclinical Dysfunction in Patients with Thalassemia Major

et al. 2022

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“…T2* parameter obtained from cardiac magnetic resonance imaging (MRI) can demonstrate tissue iron concentration nonlinearly and allows early detection of myocardial iron overload 23 . Feature tracking by cardiac MRI is capable of providing a more comprehensive evaluation of cardiac contractile ability by expressing longitudinal, circumferential, and radial values 24 . It is stated in several studies that strain values can be associated with myocardial iron overload when assessed with T2* value 25,26 …”

Section: Introductionmentioning

confidence: 99%

Role of feature tracking cardiac magnetic resonance imaging in early detection of cardiac dysfunction in β‐thalassemia patients recovered from COVID‐19: A cross‐sectional study

Houshmand,

Parsaee,

Najmafshar

et al. 2024

Health Science Reports

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Background and Aimsβ‐Thalassemia patients may have cardiac complications due to iron overload, which puts them at higher risk of cardiac complications induced by coronavirus disease 2019 (COVID‐19) compared with the normal population. The present study aims to evaluate early cardiovascular complications following iron overload in β‐thalassemia patients who had early recovery from COVID‐19 by cardiac magnetic resonance imaging (MRI) and feature‐tracking technique.MethodsThirty‐two confirmed COVID‐19‐recovered β‐thalassemia cases were evaluated within 3 weeks to 3 months after a positive reverse‐transcriptase polymerase chain reaction COVID‐19 test. Both the heart and liver of all patients were examined using cardiac MRI.ResultsWe analyzed 32 patients with mean age of 32.84 ± 6.45 years at baseline. Left ventricular global strain values were significantly associated with myocardial T2*. A cut‐off value of −15.08% for global longitudinal strain (GLS) with sensitivity and specificity of 90% and 61.1% (p = 0.017), 32.33% for global radial strain (GRS) with sensitivity and specificity of 80% and 94.4% (p = 0.001) and −16.21 for global circumferential strain (GCS), with sensitivity and specificity of 80% and 89.9% (p = 0.013) may indicate cardiac iron overload.ConclusionGLS, GRS, and GCS were significantly decreased in patients with myocardial T2* <20 ms (iron overload), while no significant change was observed in the right and left ventricular ejection fraction (RV‐ and LVEF). Cardiac MRI feature‐tracking may be helpful in the early detection of cardiac complications resulting from iron overload in β‐thalassemia patients who had early recovery from COVID‐19.

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Quantification of Cardiac Iron Overload at 3 T MRI in a Rabbit Model Utilizing ME–GRE T2* Sequence

Liang,

Xiao,

et al. 2024

Magnetic Resonance Imaging

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BackgroundMyocardial iron overload can lead to myocardial dysfunction, muscle cell injury, and end‐stage heart failure. The enhanced signal‐to‐noise ratio and technical advancements have made 3 T magnetic resonance imaging (MRI) more accessible in clinical settings. However, 3 T assessments for early diagnosis of myocardial iron overload are scarce.PurposeTo evaluate the feasibility of myocardial iron quantification using 3 T MRI in a rabbit model of iron overload.Study TypeAnimal model.Animal ModelOverall, 40 male New Zealand white rabbits were categorized into control (N = 8; no treatment) and experimental (N = 32; weekly 200 mg/kg iron dextran injections) groups.Sequence3 T MRI with multi‐echo gradient echo (ME–GRE) T2* sequence.AssessmentEach week, two experimental rabbits were randomly selected for blood collection to determine serum iron (SI) levels; their tissue was harvested to assess myocardial and hepatic iron deposition.Statistical TestsSpearman's rank correlation tests were used to evaluate the correlations among R2*, cardiac iron concentration (CIC), liver iron concentration (LIC), total amount of iron injected, and SI levels. P ≤ 0.05 was considered statistically significant.ResultsThe myocardial T2* value in the experimental group was significantly lower than that of the control group. An excellent correlation was observed between R2* values and CIC (r = 0.854). CIC moderately correlated with LIC (r = 0.712) and the total amount of iron injected (r = 0.698). A strong correlation was observed between the total amount of iron injected and LIC (r = 0.866). SI levels poorly correlated with the total amount of iron injected (r = 0.205, P = 0.277) and LIC (r = 0.170, P = 0.370) but fairly correlated with CIC (r = 0.415, P = 0.022).Data ConclusionA 3 T MRI with an ME–GRE sequence may serve as a noninvasive method for evaluating cardiac iron content.Evidence LevelN/ATechnical EfficacyStage 1

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Role of CMR feature-tracking derived left ventricular strain in predicting myocardial iron overload and assessing myocardial contractile dysfunction in patients with thalassemia major

Cited by 16 publications

References 50 publications

Significance of Cardiac Magnetic Resonance Feature Tracking of the Right Ventricle in Predicting Subclinical Dysfunction in Patients with Thalassemia Major

Significance of Cardiac Magnetic Resonance Feature Tracking of the Right Ventricle in Predicting Subclinical Dysfunction in Patients with Thalassemia Major

Role of feature tracking cardiac magnetic resonance imaging in early detection of cardiac dysfunction in β‐thalassemia patients recovered from COVID‐19: A cross‐sectional study

Quantification of Cardiac Iron Overload at 3 T MRI in a Rabbit Model Utilizing ME–GRE T2* Sequence

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