Cardiac T2* MRI assessment in patients with thalassaemia major and its effect on the preference of chelation therapy.
The aim of the study is to assess the relationship between T2* magnetic resonance imaging (MRI) values and age, serum ferritin level, left ventricular ejection fraction (LVEF), splenectomy status, and to identify appropriate modifications to chelation therapy based on T2* MRI results of children with thalassaemia major. Sixty-four patients with thalassaemia major (37 girls/27 boys) older than 8 years of age were enrolled in the study. Based on the first T2* MRI, the patients' myocardial iron depositions were classified into three groups: T2* MRI <10 ms (high risk group), T2* MRI 10-20 ms (medium-risk group) and T2* MRI >20 ms (low-risk group). There was no significant relationship between T2* MRI value and ages, serum ferritin levels and splenectomy status of thalassaemia major patients. The mean LVEFs were 60, 75, and 72.5 % in the high-, medium-, and low-risk groups, respectively (P = 0.006). The mean cardiac iron concentrations calculated from the T2* MRI values were 4.96 ± 1.93, 1.65 ± 0.37, and 0.81 ± 0.27 mg/g in the high-, medium-, and low-risk groups, respectively. Chelation therapies were re-designed in 24 (37.5 %) patients according to cardiac risk as assessed by cardiac T2* MRI. In conclusion, until recently, T2* MRI has been employed to demonstrate cardiac siderosis without a direct relationship with the markers used in follow-up of patients with thalassaemia. However, modifications of chelation therapies could reliably be planned according to severity of iron load displayed by T2* MRI.
Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Turgut Ozal cad No. 1, Halkali, 34306, Istanbul, Turkey, arzuakcay@yahoo.com.
Arzu
A
Akcay
Zafer
Z
Salcioglu
Kazim
K
Oztarhan
Deniz
D
Tugcu
Gonul
G
Aydogan
Nuray Aktay
NA
Ayaz
Helen
H
Bornaun
Hulya Sayilan
HS
Sen
Ferhan
F
Akici
Burhan
B
Akdana
D000293:Adolescent; D000328:Adult; D002648:Child; D004452:Echocardiography; D005260:Female; D005293:Ferritins / Q000097:blood; D006321:Heart / Q000503:physiopathology; D006801:Humans; D007501:Iron / Q000378:metabolism; D007502:Iron Chelating Agents / Q000627:therapeutic use*; D019190:Iron Overload / Q000175:diagnosis* / Q000188:drug therapy* / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology*; D013156:Splenectomy; D013318:Stroke Volume; D065227:Transfusion Reaction; D016896:Treatment Outcome; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
D007502:Iron Chelating Agents; D005293:Ferritins; D007501:Iron