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Left atrial strain in patients with β-thalassemia major: a cross-sectional CMR study

  • Magnetic Resonance
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

The aim of this cross-sectional study was to investigate the association of left atrial (LA) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in a cohort of patients with β-thalassemia major (β-TM).

Materials and methods

We considered 264 β-TM patients (133 females, 36.79 ± 11.95 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. Moreover, we included 35 sex- and age-matched healthy controls (14 females, mean age 37.36 ± 17.52 years). Reservoir, conduit, and booster LA functions were analysed by CMR feature tracking using dedicated software.

Results

Compared to the healthy control group, β-TM patients demonstrated lower LA reservoir strain and booster strains, as well as LA reservoir and booster strain rates. However, no differences were found in LA conduit deformation parameters. In β-TM patients, ageing, sex, and left ventricle (LV) volume indexes were independent determinants of LA strain parameters. The number of segments with late gadolinium enhancement (LGE) significantly correlated with all LA strain parameters, with the exception of the LA conduit rate. Patients with cardiac complications exhibited significantly impaired strain parameters compared to patients without cardiac complications.

Conclusion

In patients with β-TM, LA strain parameters were impaired compared to control subjects, and they exhibited a significant correlation with the number of LV segments with LGE. Furthermore, patients with cardiac complications had impaired left atrial strain parameters.

Clinical relevance statement

In patients with β-thalassemia major, left atrial strain parameters were impaired compared to control subjects and emerged as a sensitive marker of cardiac complications, stronger than cardiac iron levels.

Key Points

• Compared to healthy subjects, β-thalassemia major patients demonstrated significantly lower left atrial reservoir strain and booster strains, as well as left atrial reservoir and booster strain rates.

• In β-thalassemia major, ageing, sex, and left ventricular volume indexes were independent determinants of left atrial strain parameters, while left atrial strain parameters were not correlated with myocardial iron overload.

• An independent association between reduced left atrial strain parameters and a history of cardiac complications was found in β-thalassemia major patients.

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Abbreviations

ANCOVA:

Analysis of covariance

AUC:

Area under the curve

CI:

Confidence interval

CMR:

Cardiovascular magnetic resonance

E-MIOT:

Extension-Myocardial Iron Overload in Thalassemia

HF:

Heart failure

LA:

Left atrium

LGE:

Late gadolinium enhancement

LV:

Left ventricular

MIO:

Myocardial iron overload

ROC:

Receiver operating characteristic

RV:

Right ventricular

SR:

Strain rate

β-TM:

Beta-thalassemia major

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Acknowledgements

We would like to thank all the colleagues involved in the Extension-Myocardial Iron Overload in Thalassemia project (https://emiot.ftgm.it/). We thank all patients and healthy volunteers for their cooperation.

This project is carried out within the framework of the European Reference Network on Rare Haematological Diseases (ERN-EuroBloodNet)-Project ID No 101085717. ERN-EuroBloodNet is partly co-funded by the European Union within the framework of the Fourth EU Health Programme.

Funding

The E-MIOT project received ‘no-profit support’ from industrial sponsorships (Chiesi Farmaceutici S.p.A. and Bayer). The funders had no role in study design, data collection and analysis, decision to publish, or manuscript preparation.

Author information

Authors and Affiliations

  1. Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Antonella Meloni & Vincenzo Positano

  2. Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy

    Antonella Meloni, Vincenzo Positano, Laura Pistoia & Filippo Cademartiri

  3. Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Cagliari, Italy

    Luca Saba, Michele Porcu & Riccardo Cau

  4. U.O.C. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Laura Pistoia

  5. U.O. Oncoematologia Pediatrica, Azienda Ospedaliero Universitaria Pisana – Stabilimento S. Chiara, Pisa, Italy

    Francesco Massei

  6. Servizio Trasfusionale Aziendale, Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy

    Paola Maria Grazia Sanna

  7. Unità Operativa Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria “S. Anna”, Cona, FE, Italy

    Filomena Longo

  8. Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale S. M. Goretti, Latina, Italy

    Piera Giovangrossi

  9. Centro di Talassemia, Ospedale “San Giovanni Di Dio”, Agrigento, Italy

    Crocetta Argento

  10. Unità Operativa Semplice Dipartimentale di Talassemia, Presidio Ospedaliero “Giovanni Paolo II” - Distretto AG2 di Sciacca, Sciacca, AG, Italy

    Calogera Gerardi

Authors
  1. Antonella Meloni
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  2. Luca Saba
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Corresponding author

Correspondence to Filippo Cademartiri.

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Guarantor

The scientific guarantor of this publication is Filippo Cademartiri.

Conflict of interest

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

One of the authors has significant statistical expertise.

Informed consent

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

Ethical approval

Institutional Review Board approval was obtained.

Study subjects or cohorts overlap

Some study subjects have been previously reported in other studies of the E-MIOT project evaluating iron overload.

Methodology

  • • retrospective

  • • cross-sectional study

  • • performed at one institution

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Meloni, A., Saba, L., Positano, V. et al. Left atrial strain in patients with β-thalassemia major: a cross-sectional CMR study. Eur Radiol (2024). https://doi.org/10.1007/s00330-024-10667-x

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  • DOI: https://doi.org/10.1007/s00330-024-10667-x

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