Open AccessPB2391 MYOCARDIAL CONTRACTILE FRACTION BY MAGNETIC RESONANCE AND RISK OF CARDIAC COMPLICATIONS IN THALASSEMIA MAJOR
Author(s) -
Meloni A.,
Pistoia L.,
Rosso R.,
Bitti P. P.,
Caini M.,
Carollo A.,
Armari S.,
Gerardi C.,
Roberti M. G.,
Fiorenza M. F.,
Sarli R.,
Renne S.,
Positano V.,
Pepe A.
Publication year - 2019
Publication title -
hemasphere
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 11
ISSN - 2572-9241
DOI - 10.1097/01.hs9.0000568028.34464.9f
Subject(s) - medicine , multislice , cardiology , ejection fraction , receiver operating characteristic , stroke volume , magnetic resonance imaging , complication , cardiac magnetic resonance imaging , thalassemia , cardiac magnetic resonance , heart failure , population , nuclear medicine , radiology , environmental health
Background: The analysis of cine cardiovascular magnetic resonance (CMR) images allows the quantification of the myocardial contraction fraction (MCF), a volumetric analog of myocardial deforming, that is calculated by dividing left ventricular (LV) stroke volume by LV myocardial volume. Aims: We verified the association of this new marker with myocardial iron overload and cardiac events (heart failure, arrhythmias and pulmonary hypertension) in thalassemia major (TM) patients. Methods: We considered 1492 TM patients (771 females, 31.06 ± 8.95 yrs) enrolled in the MIOT network. Myocardial iron overload (MIO) was quantified by the multislice multiecho T2∗ technique and biventricular morphological and functional parameters by cine sequences. Results: MCF values were significantly lower in males (0.94 ± 0.22 vs 1.01 ± 0.22; P < 0.0001) and decreased with increasing age (R = −0.129 P < 0.0001). Patients with MIO (global heart T2∗ < 20 ms; N = 400) showed significant lower MCF values than patients without MIO (0.91 ± 0.20 vs 1.00 ± 0.22; P < 0.0001). The patient population was randomly divided in two groups of equal size (N = 746). In the first group 99 patients had at least one cardiac complication and at receiver‐operating characteristic (ROC) curve analysis a MCF ≤ 0.87 was the best predictor of cardiac complications (area under the curve 0.659, 95% CI 0.64 to 0.69; sensitivity 60%, specificity 67%). In order to validate the result, the obtained value was tested in the remaining 746 patients (group 2). One hundred and thirty‐five patients had a cardiac complication and patients with a MCF ≤ 0.87 were more likely to have cardiac complications (odds ratio – OR = 2.73, 95%CI = 1.86‐4.01; P < 0.0001), also adjusting for cardiac iron (see Figure). Summary/Conclusion: Contractile function is reduced in patients with MIO. A MCF ≤0.87 can help to identify patients with a significant higher risk of adverse cardiovascular events, independently by the presence of MIO.