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Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia

Indian Pediatrics volume 48, Article number: 697 (2011) Cite this article

Abstract

Objective

To quantify myocardial iron stores by Cardiac Magnetic Resonance (CMR).

Design

Prospective cohort study.

Setting

Thalassemia center in a teaching hospital.

Participants

60 transfusion dependant thalassemia major patients and 10 controls during 2008–2009.

Methods

MRI T2* for cardiac iron load and cardiac functions was performed on a 1.5 Tesla Siemens Sonata machine using the thalassemia tools software. Ejection fraction (EF) was measured using standard CMR sequence and EF <56% considered as cardiac dysfunction. Quantification of iron deposition was categorized as T2* <10 milliseconds (ms) as high risk, 10–20 ms as intermediate risk and >20 ms as low risk. Simultaneous liver iron T2* values were categorized into normal i.e. >6.3 ms, mild iron overload 6.3–2.7 ms, moderate iron overload 2.7–1.4 ms and severe iron overload <1.4 ms. Pretransfusion serum ferritin levels were simultaneously determined. Data was analyzed by paired and unpaired t test of mean.

Results

Of 60 patients, 50% had no cardiac siderosis; 33.3% had mild to moderate and while 16.7% had severe cardiac siderosis. In contrast, only 8.3% had normal liver iron values, 55.7% had mild to moderate and 36% had severe iron stores. The mean serum ferritin of all 60 cases was 3528.6 ± 1958.6 ng/mL. There was a statistically significant difference in the mean cardiac T2* of patients (23.45 ± 13.4 ms) as compared to controls (32.67 ± 2.68 ms) (P<0.01).

Conclusions

Thalassemia patients had significantly higher cardiac iron stores as compared to controls. Serum ferritin and liver iron values did not correlate with cardiac iron values. Three of 10 patients <10 years showed evidence of myocardial siderosis.

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Affiliations

  1. Department of Pediatrics, Dr Balabhai Nanavati Hospital, Mumbai, India

    Rashid H. Merchant, Aditi Joshi & Javed Ahmed

  2. Piramal Diagnostics, Mumbai, India

    Pradeep Krishnan & Bhavin Jankharia

  3. 501, Rangmahal 5th floor, 2 Mount Mary Road, Bandra (West), Mumbai, 400 050, India

    Rashid H. Merchant

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  1. Rashid H. Merchant
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  2. Aditi Joshi
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Correspondence to Rashid H. Merchant.

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Merchant, R.H., Joshi, A., Ahmed, J. et al. Evaluation of cardiac iron load by cardiac magnetic resonance in thalassemia. Indian Pediatr 48, 697 (2011). https://doi.org/10.1007/s13312-011-0115-9

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  • DOI: https://doi.org/10.1007/s13312-011-0115-9

Key words

  • Cardiac siderosis
  • Magnetic resonance imaging
  • Myocardial dysfunction
  • Thalassemia