In Thalassemia major patients cardiac iron overload quantified with MRI and to evaluate the relationship between the cardiac T2* value and systolic and diastolic function on tissue Doppler echocardiography (ECHO) and MRI

ABSTRACT Purpose: Thalassemia major (TM) patients are mainly characterized by iron overload caused by regular blood transfusion. Cardiac complications are the main reasons of morbidity and mortality in TM. Magnetic resonance imaging (MRI) has gained popularity for quantitatively evaluating myocardial iron overload. Cardiac iron quantification by using 3 Tesla MRI has not been studied before as far as we could review the literature. The aim of this study is to quantify cardiac iron load at 3T MRI (with T2* relaxation technique) and to evaluate the relationship between the cardiac T2* value and liver T2* value, serum ferritin levels, systolic and diastolic function on echocardiography (ECHO) and MRI. Materials and Methods: 21 TM patients ( 13 women, 8 men; mean age, 29,3±7,6 years) and 11 normal subjects (5 women, 6 men; mean age, 32,4±5,9 years) are evaluated. Cardiac and liver iron load was asessed by 16 echo T2* GRE sequence at 3T MRI. Left ventricular functions were analyzed at ECHO and short axis, steady state free precession sequence at 3T MRI. Diastolic functions were analyzed at the Workstation using a spesific software, with volumetric filling curves and fractional-global diastolic index. Results: Cardiac iron overload (T2*<12 ms) was observed in 6 of the 21 TM patients. In TM patients diastolic and systolic dysfunction wasn't observed at ECHO. Cardiac T2* was not associated with serum ferritin levels, liver T2*, systolic and diastolic function parameters at MRI and ECHO. Inverse and significant correlation between serum ferritin levels and liver T2* were observed (r = -0,663). There was a weak correlation between MRI EF and ECHO EF (r=0,380). CONCLUSION: The early stage of cardiac iron overload can not be predicted by serum ferritin levels, liver T2* and left ventricular diastolic and systolic function parameters at MRI and ECHO. TM patients should be followed by MRI for cardiac iron overload to prevent the cardiac complications. Key words: Thalassemia major, cardiac MRI, iron overload.