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Longitudinal monitoring of cardiac siderosis using cardiovascular magnetic resonance T 2* in patients with thalassemia major on various chelation regimens: A 6‐year study
Author(s) -
Ambati Srikanth R.,
Randolph Rachel E.,
Mennitt Kevin,
Kleinert Dorothy A.,
Weinsaft Jonathan W.,
Giardina Patricia J.
Publication year - 2013
Publication title -
american journal of hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.456
H-Index - 105
eISSN - 1096-8652
pISSN - 0361-8609
DOI - 10.1002/ajh.23469
Subject(s) - siderosis , thalassemia , medicine , deferiprone , magnetic resonance imaging , deferasirox , chelation therapy , cardiac magnetic resonance , cardiology , beta thalassemia , radiology
Cardiovascular magnetic resonance (CMR) and hepatic magnetic resonance imaging (MRI) have become reliable noninvasive tools to monitor iron excess in thalassemia major (TM) patients. However, long‐term studies are lacking. We reviewed CMR and hepatic MRI T 2* imaging on 54 TM patients who had three or more annual measurements. They were managed on various chelation regimens. Patients were grouped according to their degree of cardiac siderosis: severe ( T 2*, <10 msec), mild to moderate ( T 2* = 10–20 msec), and no cardiac siderosis ( T 2*, >20 msec). We looked at the change in cardiac T 2*, liver iron concentration (LIC) and left ventricular ejection fraction (LVEF) at years 3 and 5. In patients with severe cardiac siderosis, cardiac T 2* (mean ± SD) improved from 6.9 ± 1.6 at baseline to 13.6 ± 10.0 by year 5, mean Δ T 2* = 6.7 ( P  = 0.04). Change in cardiac T 2* at year 3 was not significant in the severe group. Patients with mild to moderate cardiac siderosis had mean cardiac T 2* of 14.6 ± 2.9 at baseline which improved to 26.3 ± 9.5 by year 3, mean Δ T 2* = 11.7 ( P  = 0.01). At baseline, median LICs (mg/g dry weight) in patients with severe, mild–moderate, and no cardiac siderosis were 3.6, 2.8, and 3.3, whereas LVEFs (mean ± SD) (%) were 56.3 ± 10.1, 60 ± 5, and 66 ± 7.6, respectively. No significant correlation was noted between Δ cardiac T 2* and Δ LIC, Δ cardiac T 2*, and Δ LVEF at years 3 and 5. Throughout the observation period, patients with no cardiac siderosis maintained their cardiac T 2* above 20 msec. The majority of patients with cardiac siderosis improve cardiac T 2* over time with optimal chelation. Am. J. Hematol. 88:652–656, 2013. © 2013 Wiley Periodicals, Inc.

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