Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia.

Abstract

OBJECTIVE:

To quantify myocardial iron stores by Cardiac Magnetic Resonance (CMR).

DESIGN:

Prospective cohort study.

SETTING:

Thalassemia center in a teaching hospital.

PARTICIPANTS:

60 transfusion dependant thalassemia major patients and 10 controls during 2008-2009.

METHODS:

MRI T2* for cardiac iron load and cardiac functions was performed on a 1.5 Tesla Siemens Sonata machine using the thalassemia tools software. Ejection fraction (EF) was measured using standard CMR sequence and EF <56% considered as cardiac dysfunction. Quantification of iron deposition was categorized as T2* <10 milliseconds (ms) as high risk, 10-20 ms as intermediate risk and >20 ms as low risk. Simultaneous liver iron T2* values were categorized into normal i.e. >6.3 ms, mild iron overload 6.3-2.7 ms , moderate iron overload 2.7- 1.4 ms and severe iron overload <1.4 ms. Pretransfusion serum ferritin levels were simultaneously determined. Data was analyzed by paired and unpaired t test of mean.

RESULTS:

Of 60 patients, 50% had no cardiac siderosis; 33.3% had mild to moderate and while 16.7% had severe cardiac siderosis . In contrast, only 8.3% had normal liver iron values, 55.7% had mild to moderate and 36% had severe iron stores. The mean serum ferritin of all 60 cases was 3528.6 ± 1958.6 ng/mL. There was a statistically significant difference in the mean cardiac T2* of patients (23.45 ± 13.4 ms) as compared to controls (32.67 ± 2.68 ms) (P<0.01).

CONCLUSIONS:

Thalassemia patients had significantly higher cardiac iron stores as compared to controls. Serum ferritin and liver iron values did not correlate with cardiac iron values. Three of 10 patients <10 years showed evidence of myocardial siderosis.

• Authors: Rashid Merchant, Aditi Joshi, Javed Ahmed, Pradeep Krishnan, Bhavin Jankharia
• Journal: Indian pediatrics (Indian Pediatr) Vol. 48 Issue 9 Pg. 697-701 (Sep 2011) ISSN: 0974-7559 [Electronic] India
• PMID: 21169646 (Publication Type: Journal Article)

Chemical References

• Iron

Topics

• Adolescent
• Adult
• Case-Control Studies
• Child
• Female
• Heart Function Tests
• Humans
• Iron (analysis, metabolism)
• Iron Overload (diagnosis, metabolism)
• Magnetic Resonance Imaging (methods)
• Male
• Myocardium (chemistry, metabolism)
• Prospective Studies
• beta-Thalassemia (diagnosis, metabolism)