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

AbstractOBJECTIVE:
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.
AuthorsRashid Merchant, Aditi Joshi, Javed Ahmed, Pradeep Krishnan, Bhavin Jankharia
JournalIndian pediatrics (Indian Pediatr) Vol. 48 Issue 9 Pg. 697-701 (Sep 2011) ISSN: 0974-7559 [Electronic] India
PMID21169646 (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)

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