Cardiac iron overload evaluation in thalassaemic patients using T2* magnetic resonance imaging following chelation therapy: a multicentre cross-sectional study

Chapchap, Eduardo Cerello; Silva, Murilo Marques Almeida; Assis, Reijane Alves de; Kerbauy, Lucila Nassif; Diniz, Michelli da Silva; Rosemberg, Laércio Alberto; Loggetto, Sandra Regina; Araújo, Aderson da Silva; Fabron, Antonio; Veríssimo, Mônica Pinheiro de Almeida; Baldanzi, Giorgio Roberto; Espósito, Breno Pannia; Tricta, Fernando; Steagall, Merula Emmanoel Anargyrou; Vellozo, Claudia Ângela Galleni Di Sessa; Fertrin, Kleber Yotsumoto; Baroni, Ronaldo Hueb; Hamerschlak, Nelson

doi:10.1016/j.htct.2021.01.014

Cited by 4 publications

(2 citation statements)

References 27 publications

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“…These findings point towards improved biomarker thresholds to assess iron deficiency in patients with inflammatory conditions. In a group of thalassemic patients, an MRI method evaluated iron overload in heart, liver and pancreas tissues to measure chelation therapy response [20]. Interestingly, in this study, the authors found that serum ferritin decreased before iron overload in the liver suggesting that decreasing serum ferritin signaled improvement in iron overload in other tissues.…”

Section: Non-serum Based Assessment Methodsmentioning

confidence: 86%

Assessment of iron status

Von Holle

2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review Iron is an essential trace element in human health that can be harmful at abnormal levels such as iron overload or deficiency. Measured iron status in the body can depend on health outcomes experienced by the individual and this can complicate its accurate assessment. This review will highlight recent research on iron assessment in the literature. Recent findings Research on iron assessment within the past 18 months included some common themes spanning new methods and biomarkers, as well as existing problems in assessing iron deficiency and overload. Heterogeneity in associations between inflammation and iron levels are reflected across different inflammatory biomarkers. New methods relevant to low- and high-resource settings may improve assessment in tissues with iron deficiency and overload. Consensus papers outlined best practices when using MRI to assess iron status. Outside of newer methods, traditional serum markers are the subject of a call for updated guidance when assessing iron status. Summary Research continues on the topic of iron assessment, underlying its complex metabolism in the body and resulting challenges in assessment. Current literature underscores progress to make iron assessment more accessible, improve existing methods, and update current assessment methods so they correspond with recent research to improve human health.

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Section: Non-serum Based Assessment Methodsmentioning

confidence: 86%

Assessment of iron status

Von Holle

2024

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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“…Long-term followup imaging with T2* has improved the prognosis in thalassemia patients. [22][23][24][25] In the current study, emphasizing the importance of cardiac dysfunction in TDT patients, we mainly aimed to investigate the association between left and right ventricular (LV and RV) function measured by cardiac MRI and iron deposition estimation by CMR T2* in a sample of Iranian TDT patients.…”

Section: Introductionmentioning

confidence: 99%

The relationship of myocardial and liver T2* values with cardiac function and laboratory findings in transfusion-dependent thalassemia major patients: A retrospective cardiac MRI study

Abdi

Taheri

Haghighi

et al. 2023

J Cardiovasc Thorac Res

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Introduction: Cardiac complications are the leading cause of death in thalassemia patients. It is assumed that progressive iron accumulation results in myocyte damage. Myocardial T2* measurement by cardiac MRI quantifies iron overload. We aimed to study the association between left and right ventricular (LV and RV) function and iron deposition estimation by cardiac MRI T2* in a sample of Iranian patients. Methods: Cardiac MRI exams of 118 transfusion-dependent thalassemia major patients were evaluated retrospectively. Biventricular function and volume and myocardial and liver T2* values were measured. The demographic and lab data were registered. Poisson and chi-square regression analyses investigated the correlation between the T2* value and ventricular dysfunction. Results: The study participants’ mean (SD) age was 32.7y (9.02), and 47.46% were female. Forty-nine cases (41.52%) revealed at least uni-ventricular dysfunction. LV dysfunction was noted in 20 cases, whereas 47 patients revealed RV dysfunction. The risk of LV dysfunction was 5.3-fold higher in patients with cardiac T2* value less than 10msec (RR=5.3, 95% CI=1.6, 17.1, P<0.05). No association was found between age, liver T2* value, serum ferritin level, and chelation therapy with the risk of LV and RV dysfunction. Conclusion: Cardiac MRI T2* measure is a good indicator of LV dysfunction. Moreover, MRI parameters, especially RV functional measures, may have a substantial role in patient management. Therefore, cardiac MRI should be included in beta-thalassemia patients’ management strategies.

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Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients

Meloni,

Pistoia,

Ricchi

et al. 2024

JCM

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Objectives: This multicenter, retrospective, population-based, matched-cohort study compared clinical characteristics and magnetic resonance imaging (MRI) findings, including hepatic, pancreatic, and cardiac iron levels and cardiac function, between 135 adult regularly transfused thalassemia intermedia (TI) patients (44.73 ± 12.16 years, 77 females) and 135 age- and sex-matched thalassemia major (TM) patients (43.35 ± 9.83 years, 77 females), enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Methods: The MRI protocol included the quantification of hepatic, pancreatic, and cardiac iron levels (R2* technique), the assessment of biventricular function parameters (cine images), and the detection of replacement myocardial fibrosis (late gadolinium enhancement technique). Results: Age, sex, frequency of splenectomy and chelation, and serum ferritin levels were not significantly different (p > 0.05) between the two groups, but TI patients started regular transfusions significantly later (p < 0.0001) and showed significantly lower pre-transfusion hemoglobin levels (p = 0.005). No difference was found in hepatic iron levels (p = 0.853). TI patients exhibited significantly lower pancreatic R2* values (p < 0.0001), also correcting for the duration of regular transfusions, and significantly lower cardiac R2* values (p < 0.0001). In the receiver operating characteristic analysis, pancreatic iron was the strongest discriminator between the two diseases. Left and right ventricular end-diastolic volume indexes were significantly higher in TI than in TM patients (p = 0.003 and p = 0.046, respectively), but the correction for the duration of regular transfusions removed the disease-specific differences (p > 0.05). Left ventricular (LV) mass index was significantly higher in TI (p = 0.049), while no difference (p > 0.05) was found in biventricular ejection fractions and replacement myocardial fibrosis. Conclusions: TI patients showed lower pancreatic and cardiac iron burden and more pronounced LV hypertrophy. These differences could not be explained by the different duration of the transfusional regimen.

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Cardiac iron overload evaluation in thalassaemic patients using T2* magnetic resonance imaging following chelation therapy: a multicentre cross-sectional study

Cited by 4 publications

References 27 publications

Assessment of iron status

Assessment of iron status

The relationship of myocardial and liver T2* values with cardiac function and laboratory findings in transfusion-dependent thalassemia major patients: A retrospective cardiac MRI study

Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients

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