title: Myocardial fibrosis by late gadolinium enhancement cardiac magnetic resonance and hepatitis C virus infection in thalassemia major patients.
abstract: OBJECTIVE
  Our aim was to evaluate the correlation between myocardial fibrosis detected using the late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) technique and chronic hepatitis C (CHC) in a large, retrospective, multicentre cohort of thalassemia major patients.
  
  
  METHODS
  LGE images were acquired in 434 thalassemia major patients (233 men, 31 ± 9 years) enrolled in the MIOT (Myocardial Iron Overload in Thalassemia) study. Hepatitis C virus (HCV)-RNA tests were sensitive to detect more than 50  copies/ml.
  
  
  RESULTS
  No patient manifested moderate/severe adverse events associated with the use of Gadobutrol. Myocardial fibrosis was detected in 90 (21%) patients. Among the 312 patients tested for HCV-RNA, there was a significant correlation between the presence of myocardial fibrosis and CHC (P = 0.011). Among the 62 patients with myocardial fibrosis tested for HCV-RNA, we found a significantly higher prevalence of diabetes mellitus in CHC patients versus the no-CHC patients (P = 0.049).
  
  
  CONCLUSIONS
  Our findings support the use of the LGE CMR approach well tolerated in the thalassemia major patients with CHC. HCV infection can be involved in the pathogenesis of myocardial fibrosis through both myocarditis directly and the pancreas and liver damage with the development of diabetes indirectly. These patients could therefore benefit from cardioactive drugs and therapeutic interventions directed towards the eradication of virus.
authors.affiliation: aCMR Unit, Fondazione 'G. Monasterio' CNR-Regione Toscana, Pisa bEmatologia-Emoglobinopatie, Civico ARNAS Hospital, Palermo cDepartment of Clinical and Experimental Medicine (Pediatrics), University of Ferrara, Ferrara dHaematology II with Thalassemia, 'V. Cervello' Hospital, Palermo eRadiology Department, 'John Paul II' Catholic University, Campobasso fCentro Talassemie, ARNAS Garibaldi, Catania gUOSD Centro per le Microcitemie, AORN Cardarelli, Napoli hDepartment of Microcitemia, 'Casa Sollievo della Sofferenza' Hospital, San Giovanni Rotondo (FG) iU.O. Microcitemie, A.O. 'Bianchi-Melacrino-Morelli', Reggio Calabria jEmatologia, 'A. Perrino' Hospital, Brindisi kMicrocitemia - Azienda Unità Sanitaria Locale TA/1, Presidio Ospedaliero Centrale, Taranto lDepartment of Radiology, University of Palermo, Palermo mEpidemiology and Biostatistics Unit, Institute of Clinical Physiology, CNR, Pisa, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Pepe
authors.forename: Antonella
authors.initials: A
authors.lastname: Meloni
authors.forename: Zelia
authors.initials: Z
authors.lastname: Borsellino
authors.forename: Liana
authors.initials: L
authors.lastname: Cuccia
authors.forename: Caterina
authors.initials: C
authors.lastname: Borgna-Pignatti
authors.forename: Aurelio
authors.initials: A
authors.lastname: Maggio
authors.forename: Gennaro
authors.initials: G
authors.lastname: Restaino
authors.forename: Francesco
authors.initials: F
authors.lastname: Gagliardotto
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Caruso
authors.forename: Anna
authors.initials: A
authors.lastname: Spasiano
authors.forename: Aldo
authors.initials: A
authors.lastname: Filosa
authors.forename: Michele
authors.initials: M
authors.lastname: Centra
authors.forename: Domenico
authors.initials: D
authors.lastname: D'Ascola
authors.forename: Antonella
authors.initials: A
authors.lastname: Quarta
authors.forename: Angelo
authors.initials: A
authors.lastname: Peluso
authors.forename: Massimo
authors.initials: M
authors.lastname: Midiri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rossi
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Positano
authors.forename: Marcello
authors.initials: M
authors.lastname: Capra
mesh_terms: D000328:Adult; D003287:Contrast Media; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000175:diagnosis; D004719:Endomyocardial Fibrosis / Q000175:diagnosis*; D005260:Female; D005682:Gadolinium / Q000032:analysis*; D006321:Heart / Q000503:physiopathology; D016174:Hepacivirus / Q000235:genetics; D019698:Hepatitis C, Chronic / Q000150:complications*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000009:adverse effects*; D008297:Male; D012189:Retrospective Studies; D013789:Thalassemia / Q000150:complications*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005682:Gadolinium