Myocardial iron overload assessed by magnetic resonance imaging (MRI)T2* in multi-transfused patients with thalassemia and acquired anemias.
BACKGROUND
Cardiac complications secondary to iron overload remain a significant matter in patients with transfusion dependent anemias.


METHODS
To evaluate cardiac siderosis, Magnetic resonance imaging T2* (MRI T2*) was performed in 3 cohorts of transfusion dependent patients: 99 with thalassemia major (TM), 20 with thalassemia intermedia (TI), and 10 with acquired anemias (AA). Serum ferritin was measured and all patients underwent echocardiographic evaluation.


RESULTS
In TM patients cardiac T2* pathologic values (below 20 ms) were found in 37 patients. Serum ferritin was negatively associated with age (r=-0.32, p=0.001) and weakly with T2* values (r=-0.19, p=0.057). A positive correlation was found between T2* and LVEF (r=0.27, p=0.006). Out of 37 patients with T2*<20 ms, 18 (48%) had serum ferritin values<1000 ng/ml. In TI cohort, 3 patients had cardiac T2* pathologic values. In AA cohort, pathologic T2* values were found in 2 patients, who received 234 and 199 PRBC units, respectively, and were both on chelation therapy (in one patient ferritin value was 399 ng/ml). T2* values were negatively associated, but not significantly, with the number of PRBC transfused (r=-0.53, p=0.07).


CONCLUSIONS
In our experience, 37% of TM patients had a myocardial iron overload assessed by MRI T2*; this value is higher than in TI patients. Serum ferritin measurement was a poor predictor of myocardial siderosis. In patients with AA, more than 200 PRBC units transfused were required to induce cardiac hemosiderosis, in spite of chelation therapy and, in one patient, of normal ferritin values.
Unità Semplice di Ematologia, Ospedale Madonna delle Grazie, Matera, Italy. alberto.fragasso@libero.it
Alberto
A
Fragasso
Angela
A
Ciancio
Clara
C
Mannarella
Carlo
C
Gaudiano
Oronzo
O
Scarciolla
Carlo
C
Ottonello
Marco
M
Francone
Michele
M
Nardella
Angelo
A
Peluso
Angela
A
Melpignano
Maria Rosaria
MR
Veglio
Giovanni
G
Quarta
Cristiano
C
Turchetti
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000473:pathology / Q000628:therapy; D015913:Chelation Therapy / Q000379:methods; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007501:Iron / Q000008:administration & dosage / Q000009:adverse effects*; D019190:Iron Overload / Q000150:complications / Q000473:pathology* / Q000628:therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D013789:Thalassemia / Q000150:complications / Q000473:pathology* / Q000628:therapy*; D065227:Transfusion Reaction; D016896:Treatment Outcome
D007501:Iron