Skip to main content
SpringerLink
Log in

Comparison of global strain values of myocardium in beta-thalassemia major patients with iron load using specific feature tracking in cardiac magnetic resonance imaging

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Thalassemia defined a spectrum of diseases characterized by reduced or absent production of one of the globin chains of hemoglobin. High iron deposition in the myocardium may cause functional impairment even before any changes in left ventricular (LV) ejection fraction. These impairments may appear as changes in strain values. Early detection of myocardial dysfunction is essential for improving survival and preventing further complications. Therefore, this study aims to evaluate the cardiac strain patterns by Feature Tracking -Cardiac Magnetic Resonance Imaging (FT-CMR) method and their correlation with T2* values as a new parameter in determining myocardial iron overload (MIO). In this retrospective investigation, ninety-one patients with B-thalassemia major included from May 2016 to July 2019. Twenty-three healthy subjects, also incorporated as a control group. CMR used to evaluate ventricular volumes, LVEF, and the amount of myocardial T2*. Moreover, Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS), and Global Radial Strain (GRS) were measured and analyzed in both rights and left ventricles. Correlations of cardiac T2* with GLS, GCS, and GRS were evaluated. The optimal cutoff value of GLS for prediction of cardiac T2* < 20 ms (as an indicator of inadequate chelation) calculated as well. There were significant correlations between cardiac T2* with LV GLS, LV GCS, and right ventricular GLS (p < 0.05 for each one). Moreover, a significant difference detected between the group of TM − MIO and TM + MIO and control group in terms of GLS (p < 0.001). The optimal cutoff value of GLS for prediction of cardiac T2* < 20 ms was at − 16.5% with sensitivity and specificity of 73% and 63%, respectively. Our study demonstrates that strain values measured by FT and myocardial T2* values are correlated. FT-CMR can be considered as an efficient tool for early detection of iron deposition and its effects on cardiac tissue so that proper and timely modification could have applied to chelation therapy.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Data availability

The data supporting the findings of the article is available in the research deputy of Iran University of Medical Sciences.

References

  1. Poorzand H, Manzari TS, Vakilian F, Layegh P, Badiee Z, Norouzi F, Morovatdar N, Sani ZA (2017) Longitudinal strain in beta thalassemia major and its relation to the extent of myocardial iron overload in cardiovascular magnetic resonance. Arch Cardiovasc Imaging 5:1–5

    Google Scholar 

  2. Parsaee M, Akiash N, Azarkeivan A, Alizadeh Sani Z, Amin A, Pazoki M, Samiei N, Jalili MA, Adel MH, Rezaian N (2018) The correlation between cardiac magnetic resonance T2* and left ventricular global longitudinal strain in people with β-thalassemia. Echocardiography 35(4):438–444

    Article  Google Scholar 

  3. Cusmà Piccione M, Piraino B, Zito C et al (2013) Early identification of cardiovascular involvement in patients with b-thalassemia major. Am J Cardiol 112:1246–1251

    Article  Google Scholar 

  4. Ari ME, Ekici F, Çetin İİ et al (2017) Assessment of left ventricular functions and myocardial iron load with tissue Doppler and speckle tracking echocardiography and T2* MRI in patients with beta thalassemia major. Echocardiography 34:383–389

    Article  Google Scholar 

  5. Cheung YF, Liang XC, Chan GC et al (2010) Myocardial deformation in patients with Beta-thalassemia major: a speckle tracking echocardiographic study. Echocardiography 27:253–259

    Article  Google Scholar 

  6. Hamdy AM (2007) Use of strain and tissue velocity imaging for early detect ion of regional myocardial dysfunction in patients with beta thalassemia. Eur J Echocardiogr 8:102–109

    Article  Google Scholar 

  7. Fernandes JL (2012) Iron chelation therapy in the management of transfusion-related cardiac iron overload. Transfusion 52(10):2256–2268

    Article  CAS  Google Scholar 

  8. Karamanou AG, Hamodraka ES, Vrakas SC et al (2014) Assessment of left ventricular and atrial diastolic function using two-dimensional(2D) strain imaging in patients with β-thalassemia major. Eur J Haematol 92:59–65

    Article  CAS  Google Scholar 

  9. Carpenter JP, He T, Kirk P et al (2011) On T2* magnetic resonance and cardiac iron. Circulation 123:1519–1528

    Article  Google Scholar 

  10. Aypar E, Alehan D, Hazirolan T et al (2010) The efficacy of tissue Doppler imaging in predicting myocardial iron load in patients with beta thalassemia major:correlation with T2* cardiovascular magnetic resonance. Int J Cardiovasc Imaging 26:413–421

    Article  Google Scholar 

  11. Monte I, Buccheri S, Bottari V et al (2012) Left ventricular rotational dynamics in beta thalassemia major: a speckle-tracking echocardiographic study. J Am Soc Echocardiogr 25:1083–1090

    Article  Google Scholar 

  12. Vogel M, Anderson LJ, Holden S et al (2003) Tissue Doppler echocardiography in patients with thalassaemia detects early myocardial iron dysfunction related to myocardial iron overload. Eur Heart J 24:113–119

    Article  CAS  Google Scholar 

  13. Ramazzotti A, Pepe A, Positano V et al (2009) Multicenter validation of the magnetic resonance T2* technique for segmental and global quantification of myocardial iron. J Magn Reson Imaging 30:62–68

    Article  Google Scholar 

  14. Westwood MA, Anderson LJ, Firmin DN et al (2003) Interscanner reproducibility of cardiovascular magnetic resonance T2* measurements of tissue iron in thalassemia. J Cardiovasc Magn Reson 18:616–620

    Google Scholar 

  15. Seldrum S, Pierard S, Moniotte S et al (2011) Iron overload in polytransfused patients without heart failure is associated with subclinical alterations of systolic left ventricular function using cardiovascular magnetic resonance tagging. J Cardiovas Magn Reson 13:23

    Article  Google Scholar 

  16. Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ (2008) Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson 10(1):42

    Article  Google Scholar 

  17. Habibzadeh F, Yadollahie M, Merat A, Haghshenas M (1998) Thalassemia in Iran; an overview. Arch Irn Med 1:27–33

    Google Scholar 

  18. Chu WC, Au WY, Lam WW (2012) MRI of cardiac iron overload. J Magn Reson Imaging 36(5):1052–1059

    Article  Google Scholar 

  19. Taher A, Hershko C, Cappellini MD (2009) Iron overload in thalassaemia intermedia: reassessment of iron chelation strategies. Br J Haematol 147(5):634–640

    Article  CAS  Google Scholar 

  20. Baraldi-Junkins C, Levin HR, Kasper EK, Rayburn BK, Herskowitz A, Baughman KL (1993) Complications of endomyocardial biopsy in heart transplant patients. J Heart Lung Transplant 12(Pt 1):63–67

    CAS  PubMed  Google Scholar 

  21. Liu P, Henkelman M, Joshi J (1992) Quantification of myocardial tissue iron contents using NMR relaxation. Validation in a novel murine thalassemia model. JACC 19:187A

    Google Scholar 

  22. Chitiboi T, Axel L (2017) Magnetic resonance imaging of myocardial strain: a review of current approaches. J Magn Reson Imaging 46(5):1263–1280

    Article  Google Scholar 

  23. Pedrizzetti G, Claus P, Kilner PJ, Nagel E (2016) Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson 18(1):51

    Article  Google Scholar 

  24. Bunn HF, Forget BG (1986) Hemoglobin: molecular Genetic and Clinical aspects. WB Saunders, Philadelphia

    Google Scholar 

  25. Rund D, Rachmilewitz E (2005) Beta-thalassemia. N Engl J Med 353:1135

    Article  CAS  Google Scholar 

  26. Pennell DJ, Udelson JE, Arai AE et al (2013) Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation 128:281

    Article  CAS  Google Scholar 

  27. Weatherall DJ (1994) The thalessemias. In: Stamatoyannopoulos G, Nienhuis AW, Majerus PW (eds) Molecular basis of blood diseases, 2nd edn. WB Saunders, Philadelphia, p 157

    Google Scholar 

  28. Adams JG 3rd, Coleman MB (1990) Structural hemoglobin variants that produce the phenotype of thalassemia. Semin Hematol 27:229

    CAS  PubMed  Google Scholar 

  29. Forget BG, Pearson HA (2000) Hemoglobin synthesis and the thalassemias. In: Hoffman R, Benz EJ Jr, Shattil SJ, et al. (eds) Hematology: basic principles and practice, 3rd edn. Churchill Livingstone, New York

    Google Scholar 

  30. Kwiatkowski JL, Kim HY, Thompson AA et al (2012) Chelation use and iron burden in North American and British thalassemia patients: a report from the Thalassemia Longitudinal Cohort. Blood 119:2746

    Article  CAS  Google Scholar 

  31. Ambati SR, Randolph RE, Mennitt K et al (2013) Longitudinal monitoring of cardiac siderosis using cardiovascular magnetic resonance T2* in patients with thalassemia major on various chelation regimens: a 6-year study. Am J Hematol 88:652

    Article  CAS  Google Scholar 

  32. Borgna-Pignatti C, Meloni A, Guerrini G et al (2014) Myocardial iron overload in thalassaemia major. How early to check? Br J Haematol 164:579

    Article  CAS  Google Scholar 

  33. Origa R, Danjou F, Cossa S et al (2013) Impact of heart magnetic resonance imaging on chelation choices, compliance with treatment and risk of heart disease in patients with thalassaemia major. Br J Haematol 163:400

    Article  CAS  Google Scholar 

  34. Rachmilewitz EA, Giardina PJ (2011) How I treat thalassemia. Blood 118:3479

    Article  CAS  Google Scholar 

  35. Magrì D, Sciomer S, Fedele F et al (2008) Early impairment of myocardial function in young patients with beta-thalassemia major. Eur J Haematol. 80:515–522

    Article  Google Scholar 

  36. Giusca S, Korosoglou G, Zieschang V et al (2018) Reproducibility study on myocardial strain assessment using fast-SENC cardiac magnetic resonance imaging. Sci Rep 8(1):14100

    Article  Google Scholar 

  37. Claus P, Omar AMS, Pedrizzetti G, Sengupta PP, Nagel E (2015) Tissue tracking technology for assessing cardiac mechanics: principles, normal values, and clinical applications. JACC Cardiovasc Imaging 8(12):1444–1460

    Article  Google Scholar 

  38. Pizzino F, Meloni A, Terrizzi A, Casini T, Spasiano A, Cosmi C, Allò M, Zito C, Carerj S, Aquaro GD, Di Bella G, Pepe A (2018) Detection of myocardial iron overload by two-dimensional speckle tracking in patients with beta-thalassaemia major: a combined echocardiographic and T2* segmental CMR study. Int J Cardiovasc Imaging 34(2):263–271

    Article  Google Scholar 

  39. Garceau P, Nguyen ET, Carasso S, Ross H, Pendergrast J, Moravsky G, Bruchal-Garbicz B, Rakowski H (2011) Quantification of myocardial iron deposition by two-dimensional speckle tracking in patients with β-thalassaemia major and Blackfan-Diamond anaemia. Heart 97(5):388–393

    Article  CAS  Google Scholar 

  40. Muser D, Castro SA, Santangeli P, Nucifora G (2018) Clinical applications of feature-tracking cardiac magnetic resonance imaging. World J Cardiol 10(11):210–221

    Article  Google Scholar 

Download references

Acknowledgements

We would like to thank Iran University of Medical Sciences for founding this study. We also thank the staff of Shahid Rajaee Teaching Hospital and members of Radiology Research Center of Iran University of Medical Sciences for their great support in study development.

Funding

None.

Author information

Authors and Affiliations

  1. Shahid Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

    Nahid Rezaeian

  2. Radiology Department, Shahid Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

    Masoumeh Ahmadi Mohtasham

  3. Research Center for Evidence-Based Medicine, Iranian Evidence-Based Medicine (EBM) Center: a Joanna Briggs Institute Affiliated Group, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran

    Azad Jameel Khaleel & Neda Parnianfard

  4. Shahid Rajaei Radiology Research Center, Iran University of Medical Sciences, Tehran, Iran

    Kianoosh Kasani

  5. Department of Radiology, Imam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran

    Rosa Golshan

Authors
  1. Nahid Rezaeian
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masoumeh Ahmadi Mohtasham
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Azad Jameel Khaleel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Neda Parnianfard
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kianoosh Kasani
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Rosa Golshan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masoumeh Ahmadi Mohtasham.

Ethics declarations

Conflict of interest

The study authors declare no conflict of interest in terms of scientific collaboration and financial benefits.

Ethical approval

The study protocol was approved by the ethical committee of Shahid Rajaee hospital.

Informed consent

Written informed consent was acquired from all patients before including them in the study.

Research involving human participants and/or animal

No Animal subjects were used in the study. All research procedures were tracked by ethical standards of the responsible committee at Iran University of Medical Sciences.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rezaeian, N., Mohtasham, M.A., Khaleel, A.J. et al. Comparison of global strain values of myocardium in beta-thalassemia major patients with iron load using specific feature tracking in cardiac magnetic resonance imaging. Int J Cardiovasc Imaging 36, 1343–1349 (2020). https://doi.org/10.1007/s10554-020-01835-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-020-01835-3

Keywords

Search

Navigation