title: Myocardial scarring by delayed enhancement cardiovascular magnetic resonance in thalassaemia major.
abstract: BACKGROUND
  Cardiovascular magnetic resonance (CMR) by delayed enhancement (DE) enables visualisation of myocardial scarring, but no dedicated studies are available in thalassaemia major.
  
  
  OBJECTIVE
  To investigate the prevalence, extent, clinical and instrumental correlates of myocardial fibrosis or necrosis by DE CMR in patients with thalassaemia major.
  
  
  METHODS
  115 Patients with thalassaemia major consecutively examined at an MRI laboratory.
  
  
  METHODS
  DE images were acquired to quantify myocardial scarring. Myocardial iron overload was determined by multislice multiecho T2*. Cine images were obtained to evaluate biventricular function.
  
  
  RESULTS
  DE areas were present in 28/115 patients (24%). The mean (SD) extent of DE was 3.9 (2.4)%. In 26 patients the location of fibrosis was not specific and patchy distribution was prevalent. Two patients showed transmural DE following coronary distribution. The DE group was significantly older than the no-DE group (31 (7.7) years vs 26 (7.7) years, p = 0.004). No significant relation with heart T2* values and biventricular function was found. A significant correlation was found between the presence of DE and changes in ECG (ECG abnormal in the DE group 22/28 patients and in the no-DE group 30/87 patients; chi(2) = 14.9; p<0.001).
  
  
  CONCLUSIONS
  In patients with thalassaemia the significant presence of myocardial fibrosis/necrosis seems to be a time-dependent process correlating with cardiovascular risk factors and cardiac complications. Levels of HCV antibodies are significantly higher in the serum of patients with thalassaemia with myocardial fibrosis/necrosis. ECG changes showed a good accuracy in predicting myocardial scarring.
authors.affiliation: MRI Laboratory, Institute of Clinical Physiology, CNR, and Gabriele Monasterio Foundation, Via Moruzzi 1, 56124 Pisa, Italy. alessia.pepe@ifc.cnr.it
authors.forename: A
authors.initials: A
authors.lastname: Pepe
authors.forename: V
authors.initials: V
authors.lastname: Positano
authors.forename: M
authors.initials: M
authors.lastname: Capra
authors.forename: A
authors.initials: A
authors.lastname: Maggio
authors.forename: C L
authors.initials: CL
authors.lastname: Pinto
authors.forename: A
authors.initials: A
authors.lastname: Spasiano
authors.forename: G
authors.initials: G
authors.lastname: Forni
authors.forename: G
authors.initials: G
authors.lastname: Derchi
authors.forename: B
authors.initials: B
authors.lastname: Favilli
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: E
authors.initials: E
authors.lastname: Cracolici
authors.forename: M
authors.initials: M
authors.lastname: Midiri
authors.forename: M
authors.initials: M
authors.lastname: Lombardi
mesh_terms: D000328:Adult; D002921:Cicatrix / Q000473:pathology*; D005260:Female; D006801:Humans; D019190:Iron Overload / Q000473:pathology; D018810:Magnetic Resonance Angiography / Q000379:methods; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis / Q000473:pathology; D012189:Retrospective Studies; D017086:beta-Thalassemia / Q000473:pathology*