Role of Three‐Dimensional Speckle Tracking Echocardiography in the Quantification of Myocardial Iron Overload in Patients with Beta‐Thalassemia Major

Li, Shu‐juan; Hwang, Y.; Ha, Shau‐yin; Chan, Godfrey C. F.; Mok, Amanda Sio-Peng; Wong, Samuel Po‐Shing; Cheung, Yiu‐fai

doi:10.1111/echo.13266

Cited by 18 publications

(21 citation statements)

References 23 publications

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“…Chronic tissue hypoxia in addition to chronic anemia, nutritional deficiencies and viral infections may contribute to the different susceptibilities to iron overload and cardiac damage. Moreover, myocardial fibrosis has been revealed in CMR studies in both iron-and non-iron-overload patients [32]: longlasting consequences of previous damage could explain the contradictory results on the correlation between the actual CMR T2* signal and left ventricular deformational parameters [22][23][24][25]32]. Our results demonstrated a significant correlation between liver and heart iron load assessed by MRI-T2*, while this correlation was lost at follow-up.…”

Section: Discussionmentioning

confidence: 54%

“…Previous echocardiographic studies have reported mixed results in correlating T2* values with cardiac deformational parameters. Monte et al [22] and Li et al [23] found no correlation between left ventricular deformational parameters and T2* signals. Our study is in agreement with others [24,25], where they found a correlation of longitudinal strain with the T2* signal.…”

Section: Discussionmentioning

confidence: 94%

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Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload

Bonios

Fountas

Delaporta

et al. 2021

BMC Cardiovasc Disord

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Background Myocardial iron overload in patients with thalassemia major (TM) is one of the most important complications. The purpose of the study was to identify advanced echocardiography parameters for early identification of myocardial dysfunction during follow-up of patients with TM. Methods Forty TM patients who were 41 ± 5 years old were included in the study and divided into two groups according to cardiac magnetic resonance T2* results (Group 1: Τ2* > 25 ms, Group 2: Τ2* ≤ 25 ms). Liver T2* parameters were also measured. Conventional and deformational echocardiographic parameters were measured at baseline and approximately 2 years later. Results Thirty-two patients had Τ2* = 34 ± 4 ms (Group 1), and 8 had Τ2* = 17 ± 9 ms (Group 2). Blood consumption was 185 ± 60 and 199 ± 37 ml/kg/yr (p = 0.64), and liver T2* was 4 ± 5 and 17 ± 21 ms (p = 0.01) in Groups 1 and 2, respectively. At baseline, Group 1 had better left ventricular global longitudinal strain (GLS) (− 22 ± 3 vs. − 18 ± 5, p = 0.01) and similar left ventricular ejection fraction (LVEF) (62 ± 5% vs. 58 ± 10%, p = 0.086) than Group 2. At the 28 ± 11-month follow-up, LVEF, GLS, and T2* values in Group 1 (63 ± 3%, − 21 ± 3%, 34 ± 4 ms) and Group 2 (56 ± 11%, − 17 ± 4%, 17 ± 9 ms) did not change significantly compared to their corresponding baseline values. In 8 patients from Group 1, a worsening (> 15%) in LS (p = 0.001) was detected during follow-up, with a marginal reduction in LVEF. Conclusions GLS seems to be an efficient echocardiographic parameter for detecting hemochromatosis-related cardiac dysfunction earlier than LVEF. It also seems to be affected by other factors (free radical oxygen, immunogenetic mechanisms or viral infections) in a minority of patients, underscoring the multifactorial etiology of cardiomyopathy.

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Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 94%

Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload

Bonios

Fountas

Delaporta

et al. 2021

BMC Cardiovasc Disord

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“…Observational studies in TM patients have explored the myocardial deformation role in this field. 11) 12) 22) 23) 24) The strain quantified tissue Doppler imaging (TDI), 2- or 3-dimensional speckle tracking by echocardiography allows early detection of systolic dysfunction and is related to T2*. In thalassemia patients, myocardial deformation analysis by MR has been only performed using the tagging technique.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, LV-GLS was the only parameter that correlated with myocardial T2*, with important prognostic value in population under transfusion support. 22) …”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Myocardial Feature Tracking in Transfusion-Dependent Myelodysplastic Syndrome

Alonso-Fernández-Gatta

Martin-García

Díez-Campelo

et al. 2021

J Cardiovasc Imaging

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BACKGROUND Myocardial deformation with echocardiography allows early detection of systolic dysfunction and is related to myocardial iron overload (MIO) determined by T2* in hereditary anemias under transfusion support. Our aim was to analyze the diagnostic and prognostic usefulness of magnetic resonance feature tracking (MR-FT) myocardial strain in low-risk myelodysplastic syndromes (LR-MDS) patients. METHODS Prospective study in transfusion-dependent LR-MDS patients and healthy controls who underwent a cardiac MR-FT. We analyzed the relationships between strain MR-FT and iron overload parameters and its prognostic impact in cardiovascular events and/or death. RESULTS Thirty-one patients and thirteen controls were included. MIO (T2* < 20 ms) was detected in 9.7% of patients. Left ventricular global longitudinal strain (LV-GLS) by MR-FT was pathological (> −19.3%) in 32.3% of patients. Less negative strain values correlated with lower T2* (R = −0.37, p = 0.033) and native myocardial T1 (R = −0.39, p = 0.031) times. LV-GLS by MR-FT was significantly associated with higher incidence of the combined cardiovascular events and/or all-cause death (p = 0.047), with a cut-off value of −17.7% for predicting them (63% sensitivity and 81% specificity, area under the curve = 0.69). After adjusting analysis including demographic, biomarkers and imaging variables, a higher LV-GLS value by MR-FT remained as predictor of combined event in transfusion-dependent LR-MDS patients (hazard ratio, 0.4; confidence interval, 0.15–0.98; p = 0.045). CONCLUSIONS Longitudinal myocardial strain by MR-FT in LR-MDS patients is associated to MIO and correlates with adverse events in the follow-up, what could serve as a prognostic tool.

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“…O speckle tracking pelo ecocardiograma 3D também não tem papel estabelecido nesses pacientes, mas vem demostrando resultados favoráveis à detecção de disfunção subclínica precoce. [214][215][216] Embora a ecocardiografia possa ser usada para rastrear a sobrecarga de ferro, esse método não pode prever com precisão o conteúdo de ferro no miocárdio, diferentemente da RMC (Tabela 7).…”

Section: Miocardiopatia Siderótica (Sobrecarga De Ferro)unclassified

Posicionamento Brasileiro sobre o Uso da Multimodalidade de Imagens na Cardio-Oncologia – 2021

Melo

Paiva²,

Santos³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Role of Three‐Dimensional Speckle Tracking Echocardiography in the Quantification of Myocardial Iron Overload in Patients with Beta‐Thalassemia Major

Abstract: The LV composite index of strain, torsion, and dyssynchrony derived from 3DSTE enables sensitive detection of myocardial iron overload in patients with thalassemia.

Cited by 18 publications

References 23 publications

Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload

Left ventricular deformation mechanics over time in patients with thalassemia major with and without iron overload

Magnetic Resonance Myocardial Feature Tracking in Transfusion-Dependent Myelodysplastic Syndrome

Posicionamento Brasileiro sobre o Uso da Multimodalidade de Imagens na Cardio-Oncologia – 2021

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