The correlation between cardiac magnetic resonance T2* and left ventricular global longitudinal strain in people with β‐thalassemia

Parsaee, Mozhgan; Akiash, Nehzat; Azarkeivan, Azita; Sani, Zahra Alizadeh; Amin, Ahmad; Pazoki, Mahboubeh; Samiei, Niloufar; Jalili, Mohammad Ali; Adel, Mohammad Hassan; Rezaian, Nahid

doi:10.1111/echo.13801

Cited by 20 publications

(22 citation statements)

References 34 publications

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“…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. It is noteworthy that in our study, iron-overloaded patients had similar LVEFs compared to non-iron-overloaded patients.…”

Section: Discussionsupporting

confidence: 94%

“…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%

“…It is noteworthy that in our study, iron-overloaded patients had similar LVEFs compared to non-iron-overloaded patients. Furthermore, a previous study revealed that cardiac and liver iron-overloaded patients have impaired left ventricular global longitudinal strain compared to non-iron-overloaded patients [25]. Future studies could evaluate whether T2* signal measurements combined with deformational parameters obtained by cardiac MRI can potentially provide better risk stratification for TM patients.…”

Section: Discussionmentioning

confidence: 97%

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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: Discussionsupporting

confidence: 94%

Section: Discussionmentioning

confidence: 54%

Section: Discussionmentioning

confidence: 97%

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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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“…The GLS is altered despite preserved LV function, as assessed by the ejection fraction and seems to be helpful in the prediction of cardiovascular outcomes in the general population 13 . These methods have already been evaluated specifically in patients with β-thalassemia, demonstrating an important correlation even with cardiac damage secondary to iron overload 14 . They also present a better prognostic value for diastolic dysfunction in this group of patients than parameters evaluated in traditional echocardiography 15 .…”

Section: Discussionmentioning

confidence: 99%

Echocardiografic abnormalities in patients with sickle cell/β-thalassemia do not depend on the β-thalassemia phenotype

Benites

Cisneiros

Bastos

et al. 2019

Hematology, Transfusion and Cell Therapy

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Objectives and methods We evaluated possible relationships between echocardiographic findings and clinical and laboratory parameters, in a cohort of Brazilian patients diagnosed with sickle cell/β-thalassemia, to better understand the cardiac involvement in this disease. Results Left atrial (LA) and left ventricular (LV) dilation were found in 19.5 and 11% of patients, respectively; systolic left ventricular dysfunction was present in a single patient. There were no differences in masses and volumes of cardiac chambers comparing Sβ 0 with Sβ + patients, and no relationship between these parameters and specific complications of the disease. However, parameters of altered ventricular geometry were significantly correlated with serum creatinine, hepatic transaminases and bilirubin levels. Moreover, 3 patients presented stroke; they were significantly older [53 (41–56) × 37.5 (18–70), p = 0.048], had higher values of LV posterior wall diastolic thickness [10 (10–11) × 8 (6–14), p = 0.03], LV mass [226 (194–260) × 147 (69–537), p = 0.039] and LA/aortic ratio [1.545 (1.48–1.61) × 1.26 (0.9–1.48), p = 0.032]. Conclusions Cardiac involvement in this disease does not appear to depend on the thalassemia phenotype. The presence of signs of myocardial remodeling in this group of patients was related to multi-organ impairment and rendered a higher propensity for stroke in older patients, suggesting the need for greater vigilance and control of associated factors.

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“…Epigenetic changes resulting from activation of NF-Kβ transcription factor in the downstream of this pathway, increase the expression of VCAM, MCP-1, VEGF and MMP molecules on the ECs surface. Increased expression of these molecules reduces endothelium-dependent vasodilation, which can impair ECs structure and affects CVD development [ 69 – 71 ]. MCP-1/ICAM-1 molecules, which are expressed by increasing ROS production and subsequent epigenetic changes are associated with NF-Kβ signaling on ECs surface; they can alter ECs structure by increasing monocyte-endothelial adhesion, and subsequently induce atherosclerosis and other CVDs [ 72 , 73 ].…”

Section: The Role Of Exosome In Oxidative Stress Inductionmentioning

confidence: 99%

Exosomes: Potential Player in Endothelial Dysfunction in Cardiovascular Disease

et al. 2021

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Exosomes are spherical bilayer membrane vesicles with an average diameter of 40–100 nm. These particles perform a wide range of biological activities due to their contents, including proteins, nucleic acids, lipids, lncRNA, and miRNA. Exosomes are involved in inflammation induction, oxidative stress and apoptosis, which can be effective in endothelial dysfunction. Due to the induction of mentioned processes in the endothelial cells, the intercellular connections are destroyed, cell permeability increases and finally cell efficiency decreases and functional defects occur. Cardiovascular disease (CVDs) are of consequences of endothelial dysfunction. Thus by identifying the exosome signaling pathways, which induce inflammation, oxidative stress, and apoptosis, endothelial dysfunction and subsequently CVDs can be reduced; exosomes can be used for appropriate target therapy.

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The correlation between cardiac magnetic resonance T2* and left ventricular global longitudinal strain in people with β‐thalassemia

Abstract: The participants with cardiac iron overload had a lower GLS than those without one. This suggests that GLS may be a useful method to predict myocardial iron overload particularly in β-thalassemia patients with subclinical cardiac involvement.

Cited by 20 publications

References 34 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

Echocardiografic abnormalities in patients with sickle cell/β-thalassemia do not depend on the β-thalassemia phenotype

Exosomes: Potential Player in Endothelial Dysfunction in Cardiovascular Disease

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