Serum Ferritin Levels Correlation With Heart and Liver MRI and LIC in Patients With Transfusion-Dependent Thalassemia

Abstract

Background:Iron-loaded cardiac complication is the essential cause of mortality in patients with thalassemia. Early detection and treatment of cardiac over-load can reduce mortality.Objectives:The current study aimed to evaluate the relationship between serum ferritin levels and T2* magnetic resonance imaging (MRI) of heart and liver and liver iron concentration (LIC) to diagnose iron over load in countries with limited access.Patients and Methods:In the current cross-sectional study, 85 Iranian patients with thalassemia with the mean age of 22.7 ± 7 years were randomly selected. All patients were on regular blood transfusion. Echocardiography of heart and liver T2* MRI, determination of serum ferritin levels, and LIC were performed in all subjects at the same time. The correlation of serum ferritin levels with T2*MRI of heart and liver, and LIC was assessed. P value < 0.05 was considered statistically significant.Results:Abnormal myocardial iron load (T2* MRI < 20 ms) was detected in 58% of the patients and among whom, 36% had severe myocardial iron load (T2* MRI < 10 ms). Median and interquartile range of serum ferritin levels were 1434 and 2702 respectively in patients with thalassemia. Serum ferritin levels showed a statistically significant positive correlation with LIC (rs = 0.718, P < 0.001) and significant negative correlation with T2* Heart (rs = -0.329, P = 0.002), and T2* Liver (rs = -0.698, P < 0.001). However, Ejection fraction was not significantly correlated with serum ferritin levels in the patients (P = 0.399).Conclusions:Serum ferritin levels can be used to diagnose iron over-load in patients with thalassemiaas an alternative method in areas where T2* MRI is not available.

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

“…In this study, only 10% of studied cases (4/40) developed iron-loaded heart with either mild (5%; n = 2) or moderate (5%; n = 2) cardiac siderosis which is much less than those reported by Majd et al [31] Fig . 6 Coronal images of the liver and heart at 8 different TE (1.6-18.7ms) reveal a significant decay in both hepatic and myocardial signal that increases on longer TE imaging sequences.…”

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

“…The incidence of abnormal cardiac T2* (<20 ms) among the subjects was lower than that mentioned in other published studies from other countries. A study in Hong Kong found 50% abnormal cardiac T2* [23], and another study in Iran obtained a value of 58% [24]. Our study showed that serum ferritin level had statistically significant correlation with liver and cardiac T2*, and as previously stated, this had little clinical value to determine cardiac and hepatic risk.…”

MRI Evaluation of Hepatic Iron Overload in Chronically Transfused P-Thalassemic Children

“…Majd et al, [18] showed that serum ferritin has statistically significant positive correlation with LIC and significant negative correlation with T2* of Liver which agreed with our results. However, these correlations became non significant when the SF was above 4000ng/ml; among our patients there were ten patients with very high SF level above 4000ng/ml including one case with mild LIC and two cases with moderate LIC.…”