Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia

2010 ◽  
Vol 48 (9) ◽  
pp. 697-701 ◽  
Author(s):  
Rashid H. Merchant ◽  
Aditi Joshi ◽  
Javed Ahmed ◽  
Pradeep Krishnan ◽  
Bhavin Jankharia
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Iron ◽  
Iron Load

Prevelance of Cardiac Dysfunction in Patients with Thalassemia Major with Respect to Cardiac Magnetic Resonance.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 2013-2013
Author(s):  
Antonios Kattamis ◽  
Vasilios Berdoukas ◽  
Eleni Berdoussi ◽  
Kirikos Zannikos ◽  
Vassilios Ladis
Keyword(s):  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Dysfunction ◽  
Predictive Value ◽  
Chelation Therapy ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Cardiac Morbidity ◽  
Cardiac Iron ◽  
Iron Load

Abstract Abstract 2013 Poster Board I-1035 Background: Despite recent advances in their treatment, cardiac morbidity remains a significant concern in patients with transfusion dependent thalassemia. Cardiac magnetic resonance (CMR) has been introduced as the tool of preference in evaluating cardiac iron load in chronically-transfused patients. Data on the relationship of the degree of cardiac iron load, as assessed by CMR, and the occurrence of cardiac events are limited. Furthermore, the value of CMR in predicting cardiac event seems to change with the use of more cardioprotective iron chelating agents. Patients and Methods: Cardiac iron load was estimated by measuring the myocardial relaxation parameter T2* by CMR. Data from the first-ever CMR of 318 patients with transfusion-dependent thalassemia followed in a single institution were included in this cross-sectional study. A patient was characterized as having cardiac disease (CD) if he/she fulfilled at least one of the following criteria: Left Ventricular Shortening Fraction (LVSF) <30% as assessed by echocardiogram, arrhythmia or requiring therapy with cardiac medications for clinically evident heart dysfunction. The predictive value of CMR was estimated by reviewing the cardiac events in CD-free patients, which occurred in the period of time between the initial CMR and December 31, 2008. The mean T2* between CD-free and CD patients was compared by Student t- test, the ratio was compared by Fisher's exact test and the relative risks (RR) were estimated by logistic regression. Receiver operating characteristic analysis (ROC) was used to evaluate CMR's ability to discriminate between CD and CD-free patients. Results: At the time of their first CMR, 77 patients were characterized as having CD. Their mean T2* was significantly lower than that of the 241 CD-free patients (11.0 ± 9.4 vs 23.1 ± 11.7 ms, p< 0.001). The percentages of CD-free patients increased along with the T2* (53% with T2*<8ms, 68% with T2* between 8-14ms, 79% with T2* between 14-20 ms and 92% with T2*>20, p<0.001). The RR of having CD for patients with T2*<8ms vs 8-14ms, 14-20ms and >20ms were 1.9(p=0.07), 3.4 (p=0.006) and 10 (p<0.001 ), respectively. Similarly, RR for T2* between 8-14ms vs >20 was 5 (p<0.001) and between 14-20 ms vs >20 was 3 (p<0.018). With respect to the capability of T2* to discriminate between CD and CD-free patients, the ROC analysis estimated an area under the curve equal to 0.79 (95% C. I. 0.73-0.85). At T2* cut-off values of 20, 17, 14 and 10 ms, the %'s for sensitivity/specificity are 85.3/56, 77.9/62.8, 75/70 and 63.2/79.6 respectively. The value of CMR in predicting cardiac events in CD-free patient according to the initial T2* was 2.9/100 patient-years for T2*<8ms, 0.9/100 patient/years for T2* between 8-14ms or 14-20ms, decreasing to 0.4/100 patient-year for T2*>20ms. Conclusions: CMR is a sensitive tool in determining the risk for potential cardiac dysfunction in chronically-transfused patients. Its predictive value for occurrence of cardiac events, even in patients with severe cardiac iron load, seems to be limited in patients that change iron chelation therapy. The predictive value of CMR levels could better be assessed if patients are monitored prospectively. The implementation of CMR in the regular follow-up of the patients coincided with the changes in the chelation therapy, namely the introduction of deferiprone and deferasirox, which changed dramatically the cardiac morbidity and mortality of these patients. These changes explained at least in part the low predictive value of the CMR. Disclosures: Kattamis: Novartis: Consultancy, Honoraria, Speakers Bureau. Berdoukas:ApoPharma Inc: Consultancy, Honoraria, Speakers Bureau; Novartis: Confidentiality agreement for development of ICL 670 and attendance at Scientific Sessions sponsored by Novartis. Ladis:Novartis: Honoraria; ApoPharma Inc: Honoraria.

28Impact of non-invasive rapid cardiac magnetic resonance for the assessment of cardiomyopathies in developing countries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K D Menacho Medina ◽  
S Ramirez ◽  
D Katekaru ◽  
L Dragonetti ◽  
D Perez ◽  
...  
Keyword(s):  
Developing Countries ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Tissue Characterization ◽  
Iron Level ◽  
International Partnership ◽  
Cardiac Iron ◽  
Ischaemic Cardiomyopathy ◽  
New Diagnosis ◽  
Contrast Studies

Abstract Background Cardiovascular mortality is higher in developing countries. Part of that is suboptimal testing. Cardiac magnetic resonance (CMR) is the gold standard for measuring structure, function of the heart and adds incremental value by imaging scarring and to assess iron level. Despite the existence of MRI units, CMR is identified as a complex test, with poor training and availability in developing countries. Purpose To assess the potential impact of a faster CMR protocol at a multicentre level in developing countries; implementing it with an education program, for the assessment cardiomyopathies. Methods An international partnership. A rapid CMR protocol for the evaluation of cardiac volumes, function and tissue characterization (Cardiac Iron T2* and LGE for scar) Figure 1a. We deployed the protocol as a multicentre study: Argentina, Peru, India and South Africa accompanied by a program of education. Pre-scan clinical information, scanning data: complications, image quality and post-scan follow-up of participants for the assessment on impact, between 3 to 24 months. Results 510 scans (4 countries, 6 cities, 12 centres) were performed with the rapid CMR protocol. Contrast studies in 378 (74%). There were no scan-related complications. Quality of the studies was maintained in a high level as an average of 89%. 97% of studies responded referral's question. All patients with contrast CMR scan have had at least one 2D echocardiogram before CMR. Average scan duration was 21±6 mins for contrast studies and 12±3 for non-contrast T2* protocol. The most common underlying diagnoses were non-ischaemic cardiomyopathy in 73% of participants (including cardiac iron level assessment in 26%, HCM in 17%, DCM in 15%), 27% for ischaemic cardiomyopathy and 15% for other pathologies. 4 of the 12 participant centres started to incorporate CMR for the first time. Findings impacted management in 60% of patients, including new diagnosis in 21% of participants. See table 1, figure 1b. For just cardiac iron assessment: 1/3 of participants had iron deposited in the heart with 14% of patients in severe levels. Conclusions CMR can be delivered faster and easier. When this abbreviated protocol is enabled with education, it can be implemented in developing countries with existing technology. This protocol shows high quality exam, with an important impact on patient's management. Characteristics and impact on management Contrast studies Non-contrast studies All patients (%) 378 (74) 132 (36) Age, mean (range) years 54 (16–93) 24 (13–41) Male (%) 151 (39) 64 (48) Pre-echocardiography exam (%) 370 (98) 42 (32) Scanning duration mean (SD) 21 (6) 12 (3) Good quality exam (%) 329 (87) 120 (91) Impact on management Total All patients (%) 510 (100) Completely new diagnosis (%) 105 (21) Change/Addition of Medication (%) 128 (25) Intervention/ Surgery (%) 31 (6) Invasive angiography/biopsy (%) 25 (5) Hospital discharge/admission (%) 15 (3) TOTAL 306 (60%) SD: Standard Deviation. Acknowledgement/Funding Global Engagement UCL, UK Foreign & Commonwealth Office and The Peruvian Scientific, Technological Development and Technological Innovation (FONDECYT)

scholarly journals Prevention of Cardiomyopathy in Transfusion-Dependent Homozygous Thalassaemia Today and the Role of Cardiac Magnetic Resonance Imaging

2009 ◽  
Vol 2009 ◽  
pp. 1-4 ◽  
Author(s):  
Athanassios Aessopos ◽  
Vasilios Berdoukas ◽  
Maria Tsironi
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Cardiac Magnetic Resonance Imaging ◽  
Cardiac Disease ◽  
Iron Status ◽  
Iron Chelation ◽  
Resonance Imaging ◽  
Cardiac Iron ◽  
Cardiac Iron Overload

Transfusion and iron chelation therapy revolutionised survival and reduced morbidity in patients with transfusion-dependent beta thalassaemia major. Despite these improvements, cardiac disease remained the most common cause of death in those patients. Recently the ability to determine the degree of cardiac iron overload, through cardiac magnetic resonance imaging (CMR) has allowed more logical approaches to iron removal, particularly from the heart. The availability of two oral chelators, deferiprone and deferasirox has reduced the need for the injectable chelator deferrioxamine and an additional benefit has been that deferiprone has been shown to be more cardioprotective than deferrioxamine. This review on the prevention of cardiac disease makes recommendations on the chelation regime that would be desirable for patients according to their cardiac iron status as determined by CMR determined by CMR. It also discusses approaches to chelation management should CMR not be available.

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