Observational study of iron overload as assessed by Magnetic Resonance Imaging (MRI) in an adult population of transfusion dependent patients with beta thalassaemia: Significant association between low cardiac T2 < 10 ms and the occurrence of cardiac events
Date
2010
Authors
Patton, W.
Brown, G.
Leung, M.
Bavishi, K.
Taylor, J.
Lloyd, J.
Lee, S.
Tay, L.
Worthley, S.
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Journal article
Citation
Internal Medicine Journal, 2010; 40(6):419-426
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N. Patton, G. Brown, M. Leung, K. Bavishi, J. Taylor, J. Lloyd, S.-H. Lee, L. Tay and S. Worthley
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Abstract
Background: Thalassaemia major patients usually die from cardiac haemosiderosis. Improved strategies are required to modify this risk. Aims: To assess the significance of cardiac iron overload in patients with β thalassaemia. Method: Observational study of cardiac iron overload as assessed by magnetic resonance imaging (MRI) cardiac T2* relaxometry in 30 adult patients with transfusion-dependent β thalassaemia. Results: 11/30 patients (37%) had cardiac T2* < 10 ms, 8/30 (27%) in range10–20 ms and 11/30 (37%) > 20 ms. There was significant inverse correlation between T2* values and values for serum ferritin (SF) and liver iron concentration (LIC) and positive correlation with left ventricular ejection fraction(LVEF). Median LVEF values were 49% in patients with T2* < 10 ms and 58%in patients with T2* > 10 ms (P = 0.02). Very low T2* values <10 ms were strongly associated with the occurrence of cardiac events (congestive heart failure, arrhythmia, cardiac death): occurring in 5/11 patients with T2* < l0 ms and in 0/19 in patients with T2* > 10 ms (P = 0.003 Fisher’s exact test; P =0.002 log rank Kaplan-Meier time to event analysis). There was no significant association between T2* < 10 ms or cardiac events and traditional measures of iron overload, such as SF levels >2500 mg/L and LIC (evaluated at thresholds of >7or>15 mg/g dry weight). Conclusion: Very low cardiac T2* values <10 ms are common in adults with β thalassaemia and are significantly associated with risk of cardiac events. This permits the use of individually targeted chelation strategies which are more effective in removing cardiac iron.
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© 2010 The Authors Journal compilation © 2010 Royal Australasian College of Physicians