title: Improvement of heart iron with preserved patterns of iron store by CMR-guided chelation therapy.
abstract: OBJECTIVE
  [Formula: see text] multislice multiecho cardiac magnetic resonance (CMR) allows quantification of the segmental distribution of myocardial iron overload (MIO). We evaluated whether a preferential pattern MIO was preserved between two CMR scans in regularly chelated thalassaemia major (TM) patients.
  
  
  RESULTS
  We evaluated prospectively 259 TM patients enrolled in the MIO in Thalassaemia (MIOT) network with a CMR follow-up (FU) study at 18 ± 3 months and significant MIO at baseline. The [Formula: see text] in the 16 segments and the global value were calculated. Four main circumferential regions (anterior, septal, inferior and lateral) were defined. We identified two groups: severe (n = 80, global [Formula: see text] <10 ms) and mild-moderate MIO (n = 179, global [Formula: see text] = 10-26 ms). Based on the CMR reports, 56.4% of patients changed the chelation regimen. For each group, there was a significant improvement in the global heart as well as in regional [Formula: see text] values (P < 0.0001). At the baseline, the mean [Formula: see text] value over the anterior region was significantly lower than the values over the other regions, and the mean [Formula: see text] over the inferior region was significantly lower than the values over the septal and the lateral regions. The same pattern was present at the FU, with a little difference for patients with mild-moderate MIO.
  
  
  CONCLUSIONS
  A preferential pattern of iron store in anterior and inferior regions was present at both CMRs, with an increment of [Formula: see text] values at FU due to a baseline CMR-guided chelation therapy. The anterior region seems the region in which the iron accumulates first and is removed later.
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, Pisa 56124, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Meloni
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, Pisa 56124, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Positano
authors.affiliation: U.O.C. Ematologia con Talassemia, Ospedale Civico, Palermo, Italy.
authors.forename: Giovan Battista
authors.initials: GB
authors.lastname: Ruffo
authors.affiliation: UOSD Centro per le Microcitemie, AORN Cardarelli, Napoli, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Spasiano
authors.affiliation: U.O. Microcitemie, A.O. 'Bianchi-Melacrino-Morelli', Reggio Calabria, Italy.
authors.forename: Domenico Giuseppe
authors.initials: DG
authors.lastname: D'Ascola
authors.affiliation: Microcitemia-Azienda Unità Sanitaria Locale TA/1, Presidio Ospedaliero Centrale, Taranto, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Peluso
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, Pisa 56124, Italy.
authors.forename: Petra
authors.initials: P
authors.lastname: Keilberg
authors.affiliation: Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche 'Giovanni Paolo II', Università Cattolica del Sacro Cuore, Campobasso, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Restaino
authors.affiliation: Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti 'Umberto I-Lancisi-Salesi', Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Valeri
authors.affiliation: Struttura Complessa di Cardioradiologia-UTIC, P.O. 'Giovanni Paolo II', Lamezia Terme, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Renne
authors.affiliation: Istituto di Radiologia, Policlinico 'Paolo Giaccone', Palermo, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, Via Moruzzi, 1, Pisa 56124, Italy alessia.pepe@ftgm.it.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pepe
mesh_terms: D000328:Adult; D015913:Chelation Therapy / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D019190:Iron Overload / Q000175:diagnosis / Q000628:therapy*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D017086:beta-Thalassemia / Q000175:diagnosis / Q000628:therapy*
keywords: Cardiac magnetic resonance; Myocardial iron overload; Preferential pattern; Thalassaemia major