title: Myocardial iron load and fibrosis in long term survivors of childhood leukemia.
abstract: BACKGROUND
  We sought to assess myocardial iron load and fibrosis, which may potentially affect cardiac function, in adult survivors of childhood leukemias and their relationships with left (LV) and right ventricular (RV) function.
  
  
  METHODS
  Fifty-eight (33 males) adult survivors, aged 24.5 ± 4.4, underwent cardiac magnetic resonance (CMR) at 16.6 ± 5.8 years after completion of treatment. Myocardial iron load and fibrosis were quantified using respectively T2* scan and late gadolinium enhancement. Right and left ventricular ejection fraction (EF) was measured by CMR, while myocardial function was assessed using tissue Doppler imaging.
  
  
  RESULTS
  None of the survivors had significant myocardial iron overload (T2*<20 msec). The prevalence of LV and RV fibrosis was 9% (5/58) and 38% (22/58), respectively. Left ventricular EF was subnormal (EF 45-<55%) in 9% (5/58), while RV EF was abnormal (EF <45%) in 12% (7/58) and subnormal in 34% (20/58) of survivors. Patients with LV fibrosis had significantly lower mitral annular early diastolic velocity (P = 0.01) and smaller LV end-systolic volume (P = 0.02), while those with RV fibrosis had significantly lower tricuspid late diastolic annular velocity (P = 0.02) and early to late diastolic annular velocity ratio (P = 0.02) compared to those without. Cumulative anthracycline dose correlated with early diastolic mitral (r = -0.28, P = 0.038) and tricuspid (r = -0.40, P = 0.002) annular velocities, but not LV and RV EF or fibrosis (all P > 0.05).
  
  
  CONCLUSIONS
  Ventricular fibrosis may occur in long term survivors of childhood leukemias and is related to diastolic function in the absence of significant myocardial iron overload.
authors.affiliation: Department of Paediatrics & Adolescent Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong.
authors.forename: Yiu-Fai
authors.initials: YF
authors.lastname: Cheung
authors.forename: Wendy Wai-Man
authors.initials: WW
authors.lastname: Lam
authors.forename: Janice Jing-Kun
authors.initials: JJ
authors.lastname: Ip
authors.forename: Daniel Ka-Leung
authors.initials: DK
authors.lastname: Cheuk
authors.forename: Frankie Wai-Tsoi
authors.initials: FW
authors.lastname: Cheng
authors.forename: Janet Yee-Kwan
authors.initials: JY
authors.lastname: Yang
authors.forename: Jeffrey Ping-Wa
authors.initials: JP
authors.lastname: Yau
authors.forename: Karin Ka-Huen
authors.initials: KK
authors.lastname: Ho
authors.forename: Chi-Kong
authors.initials: CK
authors.lastname: Li
authors.forename: Rever Chak-Ho
authors.initials: RC
authors.lastname: Li
authors.forename: Hui-Leung
authors.initials: HL
authors.lastname: Yuen
authors.forename: Alvin Siu-Cheung
authors.initials: AS
authors.lastname: Ling
authors.forename: Vivian Wing-Yi
authors.initials: VW
authors.lastname: Li
authors.forename: Godfrey Chi-Fung
authors.initials: GC
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000328:Adult; D018943:Anthracyclines / Q000008:administration & dosage / Q000009:adverse effects*; D001783:Blood Flow Velocity; D005260:Female; D005355:Fibrosis / Q000139:chemically induced / Q000378:metabolism / Q000401:mortality / Q000503:physiopathology; D006331:Heart Diseases / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D006352:Heart Ventricles / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D007501:Iron; D019190:Iron Overload / Q000139:chemically induced / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D007938:Leukemia / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology / Q000503:physiopathology; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D015995:Prevalence; D017741:Survivors; D016276:Ventricular Function / Q000187:drug effects*
chemical_list: D018943:Anthracyclines; D007501:Iron
keywords: leukemia; myocardial fibrosis; myocardial iron load