title: Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia.
abstract: OBJECTIVE
  To quantify myocardial iron stores by Cardiac Magnetic Resonance (CMR).
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Thalassemia center in a teaching hospital.
  
  
  METHODS
  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.affiliation: Department of Pediatrics, Dr Balabhai Nanavati Hospital, Mumbai, India. deandoc2000@hotmail.com
authors.forename: Rashid
authors.initials: R
authors.lastname: Merchant
authors.forename: Aditi
authors.initials: A
authors.lastname: Joshi
authors.forename: Javed
authors.initials: J
authors.lastname: Ahmed
authors.forename: Pradeep
authors.initials: P
authors.lastname: Krishnan
authors.forename: Bhavin
authors.initials: B
authors.lastname: Jankharia
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D002648:Child; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D007501:Iron / Q000032:analysis / Q000378:metabolism; D019190:Iron Overload / Q000175:diagnosis* / Q000378:metabolism; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009206:Myocardium / Q000737:chemistry / Q000378:metabolism*; D011446:Prospective Studies; D017086:beta-Thalassemia / Q000175:diagnosis / Q000378:metabolism*
chemical_list: D007501:Iron