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Cardiac T2* MRI assessment in patients with thalassaemia major and its effect on the preference of chelation therapy

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Abstract

The aim of the study is to assess the relationship between T2* magnetic resonance imaging (MRI) values and age, serum ferritin level, left ventricular ejection fraction (LVEF), splenectomy status, and to identify appropriate modifications to chelation therapy based on T2* MRI results of children with thalassaemia major. Sixty-four patients with thalassaemia major (37 girls/27 boys) older than 8 years of age were enrolled in the study. Based on the first T2* MRI, the patients’ myocardial iron depositions were classified into three groups: T2* MRI <10 ms (high risk group), T2* MRI 10–20 ms (medium-risk group) and T2* MRI >20 ms (low-risk group). There was no significant relationship between T2* MRI value and ages, serum ferritin levels and splenectomy status of thalassaemia major patients. The mean LVEFs were 60, 75, and 72.5 % in the high-, medium-, and low-risk groups, respectively (P = 0.006). The mean cardiac iron concentrations calculated from the T2* MRI values were 4.96 ± 1.93, 1.65 ± 0.37, and 0.81 ± 0.27 mg/g in the high-, medium-, and low-risk groups, respectively. Chelation therapies were re-designed in 24 (37.5 %) patients according to cardiac risk as assessed by cardiac T2* MRI. In conclusion, until recently, T2* MRI has been employed to demonstrate cardiac siderosis without a direct relationship with the markers used in follow-up of patients with thalassaemia. However, modifications of chelation therapies could reliably be planned according to severity of iron load displayed by T2* MRI.

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Authors and Affiliations

  1. Pediatric Hematology-Oncology, Department of Pediatrics, Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Turgut Ozal cad No. 1, Halkali, 34306, Istanbul, Turkey

    Arzu Akcay, Zafer Salcioglu, Deniz Tugcu, Gonul Aydogan, Nuray Aktay Ayaz, Hulya Sayilan Sen & Ferhan Akici

  2. Pediatric Cardiology, Department of Pediatrics, Istanbul Kanuni Sultan Suleyman Education and Research Hospital, Istanbul, Turkey

    Kazim Oztarhan & Helen Bornaun

  3. Department of Radiology, Istanbul Sisli Etfal Education and Research Hospital, Istanbul, Turkey

    Burhan Akdana

Authors
  1. Arzu Akcay
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  2. Zafer Salcioglu
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Correspondence to Arzu Akcay.

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All authors contributed to data collection and drafting the paper.

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12185_2014_1575_MOESM1_ESM.docx

Web Table 1: General characteristics of the patients with therapy modifications made after T2* MRI. (DOCX 13 kb)

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Akcay, A., Salcioglu, Z., Oztarhan, K. et al. Cardiac T2* MRI assessment in patients with thalassaemia major and its effect on the preference of chelation therapy. Int J Hematol 99, 706–713 (2014). https://doi.org/10.1007/s12185-014-1575-1

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  • DOI: https://doi.org/10.1007/s12185-014-1575-1

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