Left ventricular diastolic function compared with T2* cardiovascular magnetic resonance for early detection of myocardial iron overload in thalassemia major.
OBJECTIVE
To compare left ventricular (LV) diastolic function with myocardial iron levels in beta thalassemia major (TM) patients, using cardiovascular magnetic resonance (CMR).


METHODS
We studied 67 regularly transfused patients with TM and 22 controls matched for age, gender, and body surface area. The early peak filling rate (EPFR) and atrial peak filling rate (APFR) were determined from high-temporal-resolution ventricular volume-time curves. Myocardial iron estimation was achieved using myocardial T2* measurements.


RESULTS
Myocardial iron loading was found in 46 TM patients (69%), in whom the EPFR correlated poorly with T2* (r = -0.20, P = 0.19). The APFR (r = 0.49, P < 0.001) and EPFR/APFR ratio (r = -0.62, P < 0.001) correlated better with T2*. The sensitivity of the diastolic parameters for detecting myocardial iron loading ranged from 4% (EPFR and APFR) to 17% (EPFR/APFR ratio).


CONCLUSIONS
Myocardial iron overload results in diastolic myocardial dysfunction, but low sensitivity limits the use of a single estimation for early detection of iron overload, for which T2* has a superior categorical limit of normality.
Westwood
Mark A
MA
Cardiovascular MR Unit, Royal Brompton Hospital and Imperial College, Sydney Street, London SW3 6NP, UK.
Wonke
Beatrix
B
Maceira
Alicia M
AM
Prescott
Emma
E
Walker
J Malcolm
JM
Porter
John B
JB
Pennell
Dudley J
DJ
D000328:Adult; D001803:Blood Transfusion / Q000379:methods; D009202:Cardiomyopathies / Q000175:diagnosis / Q000209:etiology; D016022:Case-Control Studies; D016001:Confidence Intervals; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019190:Iron Overload / Q000175:diagnosis* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000737:chemistry* / Q000378:metabolism; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D065227:Transfusion Reaction; D016277:Ventricular Function, Left; D017086:beta-Thalassemia / Q000175:diagnosis / Q000628:therapy*