Open AccessInternational survey of T2* cardiovascular magnetic resonance in -thalassemia major
Author(s) -
John Paul Carpenter,
Michael Roughton,
Dudley J. Pennell,
Taigang He,
Paul Kirk,
Lisa Anderson,
V. John B. Porter,
John M. Walker,
Renzo Galanello,
Fabrice Danjou,
Gianluca Forni,
Antonis Kattamis,
Vassilis Ladis,
Marouso Drossou,
Demetra Vini,
Andreas Michos,
Vassilios Perifanis,
Tuncay Hazırolan,
Ana G. Almeida,
Yeşim Aydınok,
Selen Bayraktaroğlu,
Mirella Rangelova,
Denka Stoyanova,
Valeria Kaleva,
Georgi Tonev,
Amal ElBeshlawy,
Mohsen Saleh Elalfy,
Ibrahim M Alnasser,
Wing Y. Au,
Shau Yin Ha,
Chi Kong Li,
Winnie Chiu-Wing Chu,
Lee Lee Chan,
Meng Yao Lu,
Lia Wahidiyat,
Manuela Merelles-Pulcini,
Juliano de Lara Fernandes,
Fernando Uliana Kay,
P. Joy Ho,
Jane S. Hankins,
Maria Domenica Cappellini,
Shahina Daar,
Jameela Sathar,
Alì Taher,
George Kontoghiorges,
Khawla Belhoul,
Alexis A. Thompson,
Janet L. Kwiatkowski,
Ru San Tan,
Isabelle Thuret,
Catherine Badens
Publication year - 2013
Publication title -
haematologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.782
H-Index - 142
eISSN - 1592-8721
pISSN - 0390-6078
DOI - 10.3324/haematol.2013.083634
Subject(s) - heart failure , medicine , magnetic resonance imaging , thalassemia , cardiology , cardiac magnetic resonance imaging , radiology
Accumulation of myocardial iron is the cause of heart failure and early death in most transfused thalassemia major patients. T2* cardiovascular magnetic resonance provides calibrated, reproducible measurements of myocardial iron. However, there are few data regarding myocardial iron loading and its relation to outcome across the world. A survey is reported of 3,095 patients in 27 worldwide centers using T2* cardiovascular magnetic resonance. Data on baseline T2* and numbers of patients with symptoms of heart failure at first scan (defined as symptoms and signs of heart failure with objective evidence of left ventricular dysfunction) were requested together with more detailed information about patients who subsequently developed heart failure or died. At first scan, 20.6% had severe myocardial iron (T2*≤ 10 ms), 22.8% had moderate myocardial iron (T2* 10-20 ms) and 56.6% of patients had no iron loading (T2*>20 ms). There was significant geographical variation in myocardial iron loading (24.8-52.6%; P<0.001). At first scan, 85 (2.9%) of 2,915 patients were reported to have heart failure (81.2% had T2* <10 ms; 98.8% had T2* <20 ms). During follow up, 108 (3.8%) of 2,830 patients developed new heart failure. Of these, T2* at first scan had been less than 10 ms in 96.3% and less than 20 ms in 100%. There were 35 (1.1%) cardiac deaths. Of these patients, myocardial T2* at first scan had been less than 10 ms in 85.7% and less than 20 ms in 97.1%. Therefore, in this worldwide cohort of thalassemia major patients, over 43% had moderate/severe myocardial iron loading with significant geographical differences, and myocardial T2* values less than 10 ms were strongly associated with heart failure and death.