<p>Effective method of evaluating myocardial iron concentration in pediatric patients with thalassemia major</p>

Abstract

Background The use of T2* magnetic resonance imaging (MRI) has been promoted by recent studies as a noninvasive method for the detection of iron overload in thalassemia major patients. This study aims to estimate the iron load in the heart and liver of thalassemia major patients using T2* MRI and to determine its correlation with the left ventricle ejection fraction and serum ferritin level. Methods Forty β-Thalassemia major patients were included in the study. We evaluated the serum ferritin level, echocardiography, cardiac T2*, myocardial iron concentration (MIC), liver iron concentration (LIC) and hepatic T2* in all patients. CMR T2* findings were categorized as normal cardiac T2* (T2* >20 ms) or abnormal cardiac T2* (T2* <20 ms). Results The study found that 85% of patients had a normal cardiac T2* value. The median serum ferritin level was 2189. A significant inverse correlation was found between the serum ferritin level and the cardiac T2* (r=−0.381, =0.015); however, the correlations between serum ferritin and the hepatic T2* and liver iron concentration were statistically non-significant ( P =0.539 and P =0.637, respectively). Additionally, the LVEF correlation was statistically non-significant with SF, hepatic T2* and cardiac T2*. Conclusion Regardless of the serum ferritin level or left ventricle function, a cardiac T2* MRI should be done for all patients with β-Thalassemia major in order to estimate the myocardial iron concentration.

Assessment of cardiac and liver iron overload by magnetic resonance imaging in patients with thalassemia major: short-term follow-up

“…Khaled et al. 15 also reported that the serum ferritin level was significantly negatively correlated with the cardiac T2* time but not with the hepatic T2* time in pediatric patients similar to those in our study. Yang et al.…”

“…In our study, there was no significant correlation between these times, which can be explained by the small number of patients in our study. Khaled et al 15 also reported that the serum ferritin level was significantly negatively correlated with the cardiac T2* time but not with the hepatic T2* time in pediatric patients similar to those in our study. Yang et al 16 described the possibility of cardiac siderosis in pediatric patients with thalassemia as young as 6 years of age in cases of poorly effective chelation therapy.…”

Correlation of T-regulatory Cells and Iron Status in β-Thalassemia Major Patients

“…The T2-weighted MRI (T2 MRI) criteria for cardiac iron overload were as follows: normal >20 milliseconds (ms), mild: 14-20 ms, moderate: 10-14 ms, and severe <10 ms. The T2 MRI criteria for hepatic iron overload were as follows: normal >6.3 milliseconds (ms), mild: 2.8-6.3 ms, moderate: 1.4-2.7 ms, severe <1.4 ms [ 6 ].…”

A double‐blind, controlled, crossover trial of amlodipine on iron overload status in transfusion dependent β‐thalassemia patients

“…Serum ferritin level cannot be used as an indicator of myocardial iron overload, because it not only depends on several affecting factors such as hormonal system, 21,22 metabolic syndrome, 23 infection, 24 renal disease 25 and liver disease 26 but also have a weak correlation with myocardial MRI T2*, 27,28 especially in the elderly 29 . Consequent to the mentioned causes, as the serum ferritin level also rises, its assessment cannot be considered an accurate predictor for body iron burden in this population 28,30 . Importantly, a reduced level of serum ferritin does not deny the possibility of iron overload‐induced cardiomyopathy 16 …”