Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major.
BACKGROUND
The goal of this study was to determine the predictive value of cardiac T2* magnetic resonance for heart failure and arrhythmia in thalassemia major.


RESULTS
We analyzed cardiac and liver T2* magnetic resonance and serum ferritin in 652 thalassemia major patients from 21 UK centers with 1442 magnetic resonance scans. The relative risk for heart failure with cardiac T2* values <10 ms (compared with >10 ms) was 160 (95% confidence interval, 39 to 653). Heart failure occurred in 47% of patients within 1 year of a cardiac T2* <6 ms with a relative risk of 270 (95% confidence interval, 64 to 1129). The area under the receiver-operating characteristic curve for predicting heart failure was significantly greater for cardiac T2* (0.948) than for liver T2* (0.589; P<0.001) or serum ferritin (0.629; P<0.001). Cardiac T2* was <10 ms in 98% of scans in patients who developed heart failure. The relative risk for arrhythmia with cardiac T2* values <20 ms (compared with >20 ms) was 4.6 (95% confidence interval, 2.66 to 7.95). Arrhythmia occurred in 14% of patients within 1 year of a cardiac T2* of <6 ms. The area under the receiver-operating characteristic curve for predicting arrhythmia was significantly greater for cardiac T2* (0.747) than for liver T2* (0.514; P<0.001) or serum ferritin (0.518; P<0.001). The cardiac T2* was <20 ms in 83% of scans in patients who developed arrhythmia.


CONCLUSIONS
Cardiac T2* magnetic resonance identifies patients at high risk of heart failure and arrhythmia from myocardial siderosis in thalassemia major and is superior to serum ferritin and liver iron. Using cardiac T2* for the early identification and treatment of patients at risk is a logical means of reducing the high burden of cardiac mortality in myocardial siderosis. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00520559.
Cardiovascular Magnetic Resonance Unit, Royal Brompton Hospital, Sydney St, London SW3 6NP, UK. d.pennell@ic.ac.uk
P
P
Kirk
M
M
Roughton
J B
JB
Porter
J M
JM
Walker
M A
MA
Tanner
J
J
Patel
D
D
Wu
J
J
Taylor
M A
MA
Westwood
L J
LJ
Anderson
D J
DJ
Pennell
D000293:Adolescent; D000328:Adult; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005293:Ferritins / Q000097:blood; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D006486:Hemosiderosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology; D006801:Humans; D007501:Iron / Q000378:metabolism; D008099:Liver / Q000000981:diagnostic imaging / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D011237:Predictive Value of Tests; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D006113:United Kingdom / Q000453:epidemiology; D017086:beta-Thalassemia / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology
D005293:Ferritins; D007501:Iron