Tissue Characterization
Antonella Meloni, PhD
Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
Antonella Meloni, PhD
Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
Vincenzo Positano, MSc
Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
Laura Pistoia, MSc
Biologist
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
Gennaro Restaino, MD
Radiologist
Gemelli Molise SpA, Fondazione di Ricerca e Cura "Giovanni Paolo II"
Campobasso, Molise, Italy
Antonino Vallone, MD
Radiologist
Azienda Ospedaliera "Garibaldi" Presidio Ospedaliero Nesima
Catania, Sicilia, Italy
Riccardo Righi, MD
Radiologist
Ospedale del Delta
Lagosanto (FE), Emilia-Romagna, Italy
Priscilla Fina, MD
Radiologist
Ospedale "Sandro Pertini"
Roma, Lazio, Italy
Ada Riva, MD
Radiologist
Ospedale “SS. Annunziata” ASL Taranto
Taranto, Puglia, Italy
Domenico Maddaloni, MD
Hematologist
Ospedale "Engles Profili"
Fabriano, Marche, Italy
Roberta Renni, MD
Hematologist
Ospedale Civile “F. Ferrari”
Casarano (LE), Italy
Antonella Massa, MD
Hematologist
Ospedale “Giovanni Paolo II”
Olbia, Italy
Crocetta Argento, MD
Hematologist
Ospedale “San Giovanni Di Dio”
Agrigento, Sicilia, Italy
Carmela Gigante, MD
Hematologist
Azienda Ospedaliera Regionale San Carlo di Potenza
Potenza, Italy
Filippo Cademartiri, MD, PhD
Radiologist
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Italy
We considered 1352 adult TM patients (708 females, 32.79±7.16 years) enrolled in the Myocardial Iron Overload in Thalassemia Network and 112 healthy subjects (50 females, 32.09±6.08 years).
LVGFI and LVEF were assessed by cine images and MIO by multislice multiecho T2*technique. Replacement myocardial fibrosis was detected by late gadolinium enhancement technique.
Results:
Significant MIO (global heart T2*< 20ms) was found in 370 (27.4%) TM patients. LVGI and LVEF were significantly lower in patients with significant MIO (global heart T2*< 20 ms) than in patients without MIO and in healthy subjects, but were comparable between TM patients without MIO and healthy subjects (Figure 1).
In TM, LVGFI was not correlated with age but was significantly lower in males than in females (44.42±7.50% vs. 47.62±7.27%; p< 0.0001).
LVGFI was significantly associated with LVEF (R=0.733; p< 0.0001).
Global heart T2* values were significantly associated with both LVGFI and LVEF, but the correlation with LVGFI was significantly stronger (p=0.0001).
LVGI was significantly lower in patients with diabetes than in patients without diabetes (43.39±8.79% vs. 46.42±7.29%; p< 0.0001) while no significant difference was detected in terms of LVEF.
Compared to LGE-negative patients, patients with replacement myocardial fibrosis had a significantly lower LVGFI (44.78±8.72% vs. 46.72±7.30%; p=0.031), besides comparable global heart T2* values.
Male sex, diabetes mellitus, significant MIO, and replacement myocardial fibrosis were the strongest predictors of LVGFI (Table 1).
Eighty-six patients had an history of HF. Compared to patients without HF, patients with a history of HF showed significantly lower global heart T2* values (24.20±13.33 ms vs. 29.36±12.16 ms; p=0.001), LVEF (57.57±10.58% vs. 61.63±7.02; p< 0.0001), and LVGFI (40.85±9.31% vs. 46.45±7.28%; p< 0.0001) (Figure 2A). A LVGFI≤44.9% predicted the presence of HF. The LVGFI showed a diagnostic performance superior to that of LVEF (area under the curve: 0.67 vs. 0.62; p=0.039) (Figure 2B).
Conclusion: In TM patients the LVGFI correlates with MIO and provides incremental diagnostic value for HF detection compared with LVEF. This simple and reliable LV functional index may potentially improve the risk stratification of TM patients.