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Left ventricular global function index is associated with myocardial iron overload and heart failure in thalassemia major patients

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Abstract

Purpose: The left ventricular global function index (LVGFI) is a comprehensive marker of cardiac performance, integrating LV morphology with global function. We explored the cross-sectional association of LVGFI with myocardial iron overload (MIO), LV ejection fraction (LVEF), myocardial fibrosis, and heart failure (HF) in β-thalassemia major (TM) patients. Methods: We considered 1352 adult TM patients (708 females, 32.79 ± 7.16years) enrolled in the Myocardial Iron Overload in Thalassemia Network and 112 healthy subjects (50 females, 32.09 ± 6.08years). LVGFI and LVEF were assessed by cine images and MIO by multislice multiecho T2* technique. Replacement myocardial fibrosis was detected by late gadolinium enhancement technique. Results: LVGFI and LVEF were significantly lower in patients with significant MIO (global heart T2*<20ms) than in patients without MIO and in healthy subjects but were comparable between TM patients without MIO and healthy subjects. In TM, LVGFI was significantly associated with LVEF (R = 0.733; p < 0.0001). Global heart T2* values were significantly associated with both LVGFI and LVEF, but the correlation with LVGFI was significantly stronger (p = 0.0001). Male sex, diabetes mellitus, significant MIO, and replacement myocardial fibrosis were the strongest predictors of LVGFI. Eighty-six patients had a history of HF and showed significantly lower global heart T2* values, LVEF, and LVGFI than HF-free patients. A LVGFI ≤ 44.9% predicted the presence of HF. The LVGFI showed a diagnostic performance superior to that of LVEF (area under the curve: 0.67 vs. 0.62; p = 0.039). Conclusion: In TM patients the LVGFI correlates with MIO and provides incremental diagnostic value for HF detection compared with LVEF.

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Acknowledgements

We would like to thank all the colleagues involved in the MIOT project (https://miot.ftgm.it/). We thank all healthy volunteers and TM patients for their cooperation. This work is generated within the European Reference Network on Rare Hematological Diseases (ERN-EuroBloodNet).

Funding

The MIOT project received “no-profit support” from industrial sponsorships (Chiesi Farmaceutici S.p.A. and ApoPharma Inc.). The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

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

    Antonella Meloni, Vincenzo Positano, Laura Pistoia & Filippo Cademartiri

  2. U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy

    Antonella Meloni & Vincenzo Positano

  3. Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, FE, Italy

    Riccardo Righi

  4. Dipartimento di Immagini, Gemelli Molise SpA, Fondazione di Ricerca e Cura “Giovanni Paolo II”, Campobasso, Italy

    Massimiliano Missere

  5. Sezione di Scienze Radiologiche, Dipartimento di Biopatologia e Biotecnologie Mediche, Policlinico “Paolo Giaccone”, Palermo, Italy

    Emanuele Grassedonio

  6. Dipartimento di Radiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti “Umberto I-Lancisi-Salesi”, Ancona, Italy

    Nicolò Schicchi

  7. Reparto di Radiologia, Presidio Ospedaliero Garibaldi-Nesima, ARNAS Garibaldi, Catania, Italy

    Antonino Vallone

  8. Dipartimento della Riproduzione e dell’Accrescimento Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria Arcispedale “S. Anna”, Ferrara, Italy

    Maria Rita Gamberini

  9. Unità Operativa Complessa Ematologia con Talassemia, ARNAS Civico “Benfratelli-Di Cristina”, Palermo, Italy

    Liana Cuccia

  10. Unità Operativa Dipartimentale Talassemia, Presidio Ospedaliero Garibaldi-Centro, ARNAS Garibaldi, Catania, Italy

    Roberto Lisi

  11. Struttura Semplice di Microcitemia, Ospedale “SS. Annunziata” ASL Taranto, Taranto, Italy

    Valerio Cecinati

  12. Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, Napoli, Italy

    Anna Spasiano

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  1. Antonella Meloni
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Meloni, A., Positano, V., Pistoia, L. et al. Left ventricular global function index is associated with myocardial iron overload and heart failure in thalassemia major patients. Int J Cardiovasc Imaging 39, 991–999 (2023). https://doi.org/10.1007/s10554-023-02792-3

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