Evaluation of cardiac iron load by t2* MRI and correlation of mri finding with serum ferritin levels in patients with beta thalassemia major

ABSTRACT Objective: Cardiac complications resulting from iron accumulation in patients with major beta-thalassemia are the main causes of death. In our study we aimed to show the relation betweena noninvasive method of cardiac MRI showing early cardiac affection caused by iron accumulationin children diagnosed with major beta-thalassemia and serum ferritin level that is frequently used to follow up iron accumulation. Materials and Methods:This study was conducted at Dicle University Faculty of Medicine, Department of PediatricHematology and Oncology between the years of 2004-2016. Patients, that were included in the study, selected from the ones whowere on regular transfusion programme, nine years old and older. Patient data was obtained from patient file records and hospital data system. Cardiac T2*MRI, liver T2*MRI, serum ferritin levels, age, gender, used chelator drug types, pre-transfusion hemoglobin values and frequency of transfusion parameters of patients were statistically compared. Results: Our study was conducted with 27 patients. The patients were between the ages of 9-19 years with an average age of 13.5 + 3 years. 11 (40.7 %) of the patients were female, 16 (59.3 %) of them were male. All the patients included in the study were being treated with chelator. Deferasirox were used by 22 (81.5%) patients, desferrioxamine were used by two (7.4 %), deferiprone was used by one (3.7 %), combined treatment of desferrioxamine+deferiprone were taken by two (7.4 %) patients. Only in one of our patients splenectomy case was encountered. Transfusion frequencies of 23 (85.2 %) patients wereonce in four weeks, four (14.8 %) patients were once in three weeks. Average ferritin value was 2794.4+2162.1 ng/ml, minimum ferritin was 509 ng/ml and maximum ferritin value was 10795 ng/ml. Cardiac T2*MRI average T2 value was 28.2+9.9ms, measured T2 minimum value was 5.42 ms and maximum value was 41.9 ms. Liver T2*MRI average T2 value was 5.2+6.6 ms, pre-transfusion average hemoglobinvalue was detected as 8.8+0.7 gr/dl. According to the applied statistical analyses a significant relation between cardiac T2 value and age was found (p=0.019).Five of the patients diagnosed with cardiac iron accumulationhad also elevated relative ferritin valuesbut a significant relation between serum ferritin levels and cardiac T2 was not found. Conclusion:In our study cardiac iron accumulation was evaluatedin patients with major beta-thalassemia; it was observed that cardiac iron accumulation of patients was related to age.Serum ferritin level was not that helpful in showing cardiac iron accumulation. Keywords: Beta Thalassemia, Heart, Ferritin, T2* MRI .