The relationships between pancreatic T2* values and pancreatic iron loading with cardiac dysfunctions,  hepatic and cardiac iron siderosis among Egyptian children and young adults with β-thalassaemia major and sickle cell disease: a cross-sectional study

Abstract

Background: Cardiac, hepatic and pancreatic T2* measured by magnetic resonance imaging (MRI) has been proven to be an accurate and non-invasive method for measuring iron overload in iron overload conditions. There is accumulating evidence that pancreatic iron can predict cardiac iron in young children because the pancreas loads earlier than the heart. The aim of our study was to assess the relationships between pancreatic T2* values and pancreatic iron loading with cardiac dysfunctions and liver and cardiac iron among patients with β-thalassaemia major (βTM) and sickle cell disease (SCD). Methods: 40 βTM and 20 transfusion-dependant SCD patients were included along with 60 healthy age and sex-matched controls. Echocardiography and Tissue Doppler Imaging were performed for all subjects as well as the control group. Hepatic, cardiac and pancreatic iron overload in cases were assessed by MRI T2*. Results: The mean age of our patients was 13.7 years with mean frequency of transfusion/year 12. Mean cardiac T2* was 32.9 ms and mean myocardial iron concentration was 0.7 mg/g; One patient had cardiac iron overload of moderate severity. Mean pancreatic T2* was 22.3 ms with 20 patients having mild pancreatic iron overload. Pancreatic T2* correlated positively peak late diastolic velocity at septal mitral annulus (r=0.269, p=0.038), peak early diastolic velocity at tricuspid annulus (r=0.430, p=0.001) and mitral annular plane systolic excursion (r=0.326, p=0.01); and negatively with end systolic pulmonary artery pressure (r=-0.343, p=0.007) and main pulmonary artery diameter (MPA) (r=-0.259, p=0.046). We couldn’t test the predictability of pancreatic T2* in relation to cardiac T2* as only one patient had cardiac T2*<20 ms. Conclusion: There was a relationship between pancreatic iron siderosis with cardiac dysfunction in multi-transfused patients with βTM and SCD. No direct relation between pancreatic iron and cardiac siderosis was detected.

Relationship between pancreatic iron overload, glucose metabolism and cardiac complications in sickle cell disease: An Italian multicentre study

“…In accordance with previous studies in patients with SCD, 16,48 we observed that pancreatic R2* was directly correlated with ferritin and LIC. No correlation was found between pancreatic and cardiac R2*, likely because all patients had no cardiac iron.…”

Pancreatic iron in pediatric transfusion‐dependent beta‐thalassemia patients: A longitudinal MRI study

“…The significant association of pancreatic R2* values with serum ferritin levels and MRI LIC values is in agreement with a previous study on a smaller population, including children with both TM and sickle cell disease 40 . Importantly, in our study, the MRI LIC provided a superior discriminatory ability for pancreatic IO compared to serum ferritin levels.…”

“…Due to the low number of patients with myocardial IO, we could not perform a ROC curve analysis to detect the best pancreatic R2* cutoff for the prediction of significant myocardial siderosis. The discrepancy with two previous studies on pediatric patients that failed to detect a correlation between pancreatic and cardiac iron can be explained by the smaller sample size of these studies and the different backgrounds of the patients 24,40 . It deserves mention that the comparison with the study by Salama et al.…”

“…It deserves mention that the comparison with the study by Salama et al. was confounded by the fact that the population was constituted not only by children with TM but also included children with sickle cell disease 40 …”

“…24,40 It deserves mention that the comparison with the study by Salama et al was confounded by the fact that the population was constituted not only by children with TM but also included children with sickle cell disease. 40 In line with the study by Wahidiyat et al, 24 we did not find a significant association between pancreatic R2* values and fasting glucose.…”