title: Different patterns of myocardial iron distribution by whole-heart T2* magnetic resonance as risk markers for heart complications in thalassemia major.
abstract: BACKGROUND
  The multislice multiecho T2* cardiovascular magnetic resonance (CMR) technique allows to detect different patterns of myocardial iron overload (MIO). The aim of this cross-sectional study was to verify the association between cardiac complications (heart failure and arrhythmias), biventricular dysfunction and myocardial fibrosis with different patterns of MIO in thalassemia major (TM) patients.
  
  
  METHODS
  We considered 812 TM patients enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network. The T2* value in all the 16 cardiac segments was evaluated.
  
  
  RESULTS
  We identified 4 groups of patients: 138 with homogeneous MIO (all segments with T2* < 20 ms), 97 with heterogeneous MIO (some segments with T2* < 20 ms, others with T2* ≥ 20 ms) and significant global heart iron (global heart T2* < 20 ms), 238 with heterogeneous MIO and no significant global heart iron, and 339 with no MIO (all segments with T2* ≥ 20 ms). Compared to patients with no MIO, patients with homogeneous MIO were more likely to have cardiac complications (odds ratio-OR = 2.67), heart failure (OR = 2.54), LV dysfunction (OR = 5.59), and RV dysfunction (OR = 2.26); patients with heterogeneous MIO and significant global heart iron were more likely to have heart failure (OR = 2.38) and LV dysfunction (OR = 2.39).
  
  
  CONCLUSIONS
  Cardiac complications, heart failure and dysfunction were correlated with MIO distribution with an increasing risk from the TM patients with no MIO to those with homogeneous MIO. Using a segmental approach, early iron deposit or homogeneous MIO patterns can be characterized to better tailor chelation therapy.
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Meloni
authors.affiliation: Radiology Department, "John Paul II" Catholic University, Campobasso, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Restaino
authors.affiliation: Ematologia-Emoglobinopatie, Civico Hospital-ARNAS, Palermo, Italy.
authors.forename: Zelia
authors.initials: Z
authors.lastname: Borsellino
authors.affiliation: Centro Microcitemia, "Garibaldi" Hospital, Catania, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Caruso
authors.affiliation: Centro per la Cura delle Microcitemie, Cardarelli Hospital, Napoli, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Spasiano
authors.affiliation: Centro trasfusionale, Osp. Giovanni Paolo II, Olbia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Zuccarelli
authors.affiliation: Radiology Department, University of Ancona, Ancona, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Valeri
authors.affiliation: Istituto di Radiologia, Policlinico "Paolo Giaccone", Palermo, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Toia
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Salvatori
authors.affiliation: CMR Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Positano
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, Pisa, Italy. Electronic address: alessia.pepe@ftgm.it.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pepe
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006331:Heart Diseases / Q000175:diagnosis / Q000378:metabolism; D006801:Humans; D007501:Iron / Q000378:metabolism*; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D009206:Myocardium / Q000378:metabolism*; D012307:Risk Factors; D055815:Young Adult; D017086:beta-Thalassemia / Q000175:diagnosis* / Q000378:metabolism*
chemical_list: D007501:Iron
keywords: Cardiac complications; Cardiovascular magnetic resonance; Myocardial iron overload; Thalassemia major