Optimal method for early detection of cardiac disorders in thalassemia major patients: magnetic resonance imaging or echocardiography?

Abstract

BackgroundHeart failure resulting from myocardial iron deposition is the most important cause of death in β-thalassemia major (TM) patients. Cardiac T2*magnetic resonance imaging (MRI), echocardiography, and serum ferritin level serve as diagnostic methods for detecting myocardial iron overload. In this study, we aimed to evaluate the relationship between the above-mentioned methods.MethodsT2*MRI and echocardiographic measurement of left ventricular (LV) systolic and diastolic function were performed in 63 patients. Serum ferritin level was measured. The relationships between all assessments were evaluated.ResultsThere were 40 women and 23 men with a mean age of 23.7±5.1 years (range, 15-35 years). There was no statistically significant correlation between serum ferritin level and LV systolic and diastolic function (P=0.994 and P=0.475, respectively). T2*MRI results had a significant correlation with ferritin level; 63.6% of patients with serum ferritin level >2,000 ng/mL had abnormal cardiac MRI, while none of the patients with ferritin level <1,000 ng/mL had abnormal cardiac MRI (P=0.001). There was no significant correlation between MRI findings and LV systolic function (P=1.00). However, we detected a significant difference between LV diastolic function and cardiac siderosis (P=0.03)ConclusionMRI findings are a good predictor of future cardiac dysfunction, even in asymptomatic TM patients; however, diastolic dysfunction may happen prior to cardiac siderosis in some patients, and echocardiography is able to diagnose this diastolic dysfunction while T2*MRI shows normal findings.

Evaluation of cardiac and hepatic iron overload in thalassemia major patients with T2* magnetic resonance imaging

“…Those normal values could be interpreted as normal cardiac function. This supports the concept that conventional echocardiography is not sufficiently sensitive to pick up cardiac dysfunction and therefore does not permit early intervention [18]. Several studies concluded that tissue Doppler echocardiography was better than conventional echocardiography to distinguish cardiac dysfunction [19,20], and also correlates significantly with cardiac T2* [21].…”

Assessment of left ventricular functions and myocardial iron load with tissue Doppler and speckle tracking echocardiography and T2* MRI in patients with β‐thalassemia major

“…TDI has been used to show systolic and diastolic function of the left ventricle for many years. It was reported that myocardial systolic (S m ) and diastolic (E m , A m ) velocities in the basal and middle segments of the left ventricle were lower in patients with BTM in previous studies . This decrease has been higher in patients with T2* <20 ms .…”

“…Previous studies have reported that tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) can detect early myocardial dysfunction in BTM patients. STE is a new noninvasive echocardiographic method for the analysis of regional and global myocardial dysfunction . Although STE has been recently started to use in children, the studies evaluating the myocardial function in children with BTM patients with STE are scarce in the literature …”

MRI evaluation of hepatic and cardiac iron burden in pediatric thalassemia major patients: spectrum of findings by T2*

“…Measuring serum ferritin level remains the primary screening test and is still used in monitoring the efficacy of chelation therapy. It has been reported that serum ferritin level greater than 2500 ng/ml is considered an important risk factor for developing ironinduced complications such as liver cirrhosis, heart failure, arrhythmias, impaired growth, and delayed puberty [22][23][24][25].…”