Improved Cardiac Iron One Year After Including Rapid Magnetic Resonance Imaging Scanning in a Thalassaemia Medical Camp: Ultrafast MRI For Iron Management in India – The UMIMI Study

Abstract

Background: Survival in transfusion dependent thalassemia is closely linked to iron overload with severe cardiac iron causing heart failure. MRI guided chelation improves survival in high income countries. We explored the use of rapid MRI to guide therapy in a Lower Middle Income Country (LMIC), India, via locally organized thalassemia patient medical camps. Methods: Rapid cardiac MRI (rCMR) was implemented at two sites with clinical assessment and therapy recommendations based on rCMR findings. Investigations and clinical reassessment were repeated at 13 months. Findings: The baseline visit was attended by 103 patients, the second by 86. Average time of scanning was 10 minutes. At baseline 29% had a cardiac T2* = 17ms). At 13 months more patients were taking 2 oral chelators (21% to 37%, p<0.0001). In those with cardiac siderosis (baseline T2* <20ms) there was an improvement in T2*: 10·9ms ±5·9 to 13·5ms ±8·7, p=0·005; fewer were classified as having clinically important cardiac iron loading (T2*<20ms), 24% vs 16% (p<0·001). Interpretation: For thalassaemia patients in a LMIC, rCMR linked to therapeutic recommendation via the patient camp model led to enhanced chelation therapy and reduced cardiac iron within 1 year. Funding Information: National Institute for Health Research University College London Hospitals, the UCLH Charity and the Maurice Hatter Foundation. KMM: The Peruvian Scientific, Technological Development and Technological Innovation (FONDECYT). Support was obtained from the UCL:AIIMS working group, Thalassaemics India and the Global Engagement Office, University College London. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: Ethical approval was obtained in 3 sites: United Kingdom - University College London - UCL REC Project ID/Title: 11255/001 and in India - Institutional Ethics Committee –Clinical Studies, New Delhi: Reg. ECR/5/Inst/DL/2013/RR-16 and in Jaipur: N –IEC/2019/01. Consent was obtained by local clinicians.