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Role of CMR feature-tracking derived left ventricular strain in predicting myocardial iron overload and assessing myocardial contractile dysfunction in patients with thalassemia major

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Abstract

Objective

Myocardial iron overload (MIO) in thalassemia major (TM) may cause subclinical left ventricular (LV) dysfunction which manifests with abnormal strain parameters before a decrease in ejection fraction (EF). Early detection of MIO using cardiovascular magnetic resonance (CMR)-T2* is vital. Our aim was to assess if CMR feature-tracking (FT) strain correlates with T2*, and whether it can identify early contractile dysfunction in patients with MIO but normal EF.

Methods

One hundred and four consecutive TM patients with LVEF > 55% on echocardiography were prospectively enrolled. Those fulfilling the inclusion criteria underwent CMR, with T2* being the gold standard for detecting MIO. Group 1 included patients without significant MIO (T2* > 20 ms) and group 2 with significant MIO (T2* < 20 ms).

Results

Eighty-six patients (mean age, 17.32 years, 59 males) underwent CMR. There were 68 (79.1%) patients in group 1 and 18 (20.9%) in group 2. Fourteen patients (16.3%) had mild-moderate MIO, and four (4.6%) had severe MIO. Patients in group 2 had significantly lower global radial strain (GRS). Global longitudinal strain (GLS) and global circumferential strain (GCS) did not correlate with T2*. T1 mapping values were significantly lower in patients with T2* < 10 ms than those with T2* of 10–20 ms; however, FT-strain values were not significantly different between these two groups.

Conclusion

CMR-derived GRS, but not GLS and GCS, correlated with CMR T2*. GRS is significantly decreased in TM patients with MIO and normal EF when compared with those without. FT-strain may be a useful adjunct to CMR T2* and maybe an early marker of myocardial dysfunction in TM.

Key Points

• A global radial strain of < 29.3 derived from cardiac MRI could predict significant myocardial iron overload in patients with thalassemia, with a sensitivity of 76.5% and specificity of 66.7%.

• Patients with any myocardial iron overload have significantly lower GRS, compared to those without, suggesting the ability of CMR strain to identify subtle myocardial contractile disturbances.

• T1 and T2 mapping values are significantly lower in those with severe myocardial iron than those with mild-moderate iron, suggesting a potential role of T1 and T2 mapping in grading myocardial iron.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

FT-strain:

Feature-tracking strain

GCS:

Global circumferential strain

GLS:

Global longitudinal strain

GRS:

Global radial strain

HF:

Heart failure

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

MIO:

Myocardial iron overload

ST-strain:

Speckle-tracking strain

TM:

Thalassemia major

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Vineeta Ojha and Kartik P. Ganga contributed equally and share the first authorship.

Authors and Affiliations

  1. Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, 110029, India

    Vineeta Ojha, Kartik P. Ganga, Priya Jagia, Gurpreet S. Gulati, Sanjeev Kumar & Sanjiv Sharma

  2. Department of Haematology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Tulika Seth

  3. Department of Cardiology, All India Institute of Medical Sciences, New Delhi, 110029, India

    Ambuj Roy & Nitish Naik

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  1. Vineeta Ojha
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Correspondence to Sanjeev Kumar.

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Guarantor

The scientific guarantor of this publication is Dr. Sanjeev Kumar, Department of Cardiovascular Radiology and Endovascular Interventions, AIIMS.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Statistics was done using SPSS version 23. One of the authors (VO) has significant knowledge of statistical methods.

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Written informed consent was obtained from all subjects (patients) in this study.

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AIIMS Institutional Review Board approval was obtained for this study.

Study subjects or cohorts overlap

Consecutive thalassemia major patients were the study subjects. No overlap of the study cohort with any prior study.

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Ojha, V., Ganga, K.P., Seth, T. et al. Role of CMR feature-tracking derived left ventricular strain in predicting myocardial iron overload and assessing myocardial contractile dysfunction in patients with thalassemia major. Eur Radiol 31, 6184–6192 (2021). https://doi.org/10.1007/s00330-020-07599-7

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