Tissue Characterization

1315827 - Heart failure in thalassemia major: time for new cardiovascular magnetic resonce markers?

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

Antonella Meloni, PhD

Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy

Primary Author(s)

Antonella Meloni, PhD

Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy

Co-Author(s)

LP

Laura Pistoia, MSc

Biologist
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
NM

Nicola Martini, PhD

Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
VP

Vincenzo Positano, MSc

Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Toscana, Italy
CP

Cristina Paci, MD

Hematologist
Ospedale “S Maria alla Gruccia”
Montevarchi (AR), Toscana, Italy
RM

Roberto Mattei, MD

Hematologist
A.U.L.S.S. 5 Polesani
Adria (RO), Italy
AE

Angela Ermini, MD

Hematologist
Ospedale S. Maria Annunziata
Bagno a Ripoli (FI), Italy
VS

Vincenzo Spadola, MD

Hematologist
Azienda Ospedaliera Civile - O.M.P.A. Ragusa
Ragusa, Italy
MM

Mauro Murgia, MD

Hematologist
Ospedale San Martino di Oristano
Oristano, Italy
MS

Michele Santodirocco, MD

Hematologist
Ospedale Casa Sollievo della Sofferenza IRCCS
San Giovanni Rotondo (FG), Italy
AB

Angelica Barone, MD

Hematologist
Azienda Ospedaliero-Universitaria di Parma
Parma, Italy
PG

Piera Giovangrossi, MD

Hematologist
Ospedale S. M. Goretti
Latina, Italy
GA

Gianna Alberini, MSc

Computer scientist
Fondazione G. Monasterio CNR Regione Toscana
Massa, Italy
FC

Filippo Cademartiri, MD, PhD

Radiologist
Fondazione G. Monasterio CNR Regione Toscana
Pisa, Italy

Background:

Altough T2* cardiovascular magnetic resonance (CMR) represents the non-invasive gold standard for myocardial iron overload (MIO) assessment, native myocardial T1 mapping was demonstrated more sensitive in presence of small amounts of iron. The myocardial extracellular volume (ECV) by CMR has been introduced as a surrogate marker of diffuse interstitial myocardial fibrosis, significantly associated with MIO.

Our aim was to explore the clinical impact of ECV mapping for detecting heart failure in thalassemia major (TM).

Methods:

108 β-TM patients (62 females, 40.16±8.83 years), consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network, underwent CMR. T2* and native and post-contrast T1 values were assessed in all 16 myocardial segments. Segmental ECV values were calculated with input of native and post-contrast myocardial segmental and blood pool T1 values and same-day hematocrit. Global value was the mean of all segmental values.

Results:

Demographic, clinical, and CMR characteristics of TM patients are summarized in Table 1.

Patients without and with at least one cardiovascular risk factor showed comparable global ECV values (31.89±5.65% vs 33.00±7.46%; P=0.404).

N-terminal pro-BNP levels, a proven diagnostic biomarker for the diagnosis and prognosis of patients with heart failure, were significantly correlated with global ECV values (R=0.237; P=0.016) but not with global heart T2* or T1 values.

Significant MIO (global heart T2*< 20 ms) was found in 9 (8.3%) patients. Global ECV values were significantly higher in patients with significant MIO than in patients without significant MIO (40.07±10.62% vs 31.85±5.71%; P=0.049).

Ten (9.3%) patients had a history of heart failure. Compared to patients without heart failure, patients with a history of heart failure showed significantly lower global heart T1 values (882.68±125.46 ms vs 962.66±81.90 ms; P=0.047) and significantly higher global heart ECV values (36.63±9.41 vs 32.12±6.14 ms; P=0.039) (Figure 1). Global heart T2* values tended to be lower in patients with heart failure than in patients free of heart failure, but the difference was not significant (30.44±14.53 vs 38.24±8.63 ms; P=0.077).

Conclusion:

In our population of well treated patients, generally not heavily loaded at the cardiac level, native T1 and ECV values turned out to be a associated with heart failure, more strongly than global heart T2* values. So, when possible, the ECV assessment should be included in the routine CMR of TM patients. Longitudinal prospective studies are needed to clarify the temporal association between MIO and diffuse fibrosis. Moreover, the potential of treatments targeted at interstitial fibrosis to reduce the risk of heart failure should be investigated, especially in TM patients refractory to iron chelating therapy.