Left and Right Ventricular Wall Motion Abnormalities In Thalassemia Major Patients

Abstract

IntroductionLeft ventricular (LV) and right ventricular (RV) wall motion abnormalities can be detected through a qualitative analysis of cine magnetic resonance (MR) images. Moreover, MR is the gold standard technique for the evaluation of myocardial iron overload (MIO), biventricular global systolic function and myocardial fibrosis. We investigated the relationships between LV movement abnormalities and MIO, LV function and myocardial fibrosis as well as between RV motion and function in thalassemia major (TM) patients. MethodsCMR was performed in 1092 TM patients (537 male; 30.6±8.5 years) enrolled in the Myocardial Iron Overload in Thalassemia Network. Cine images were acquired to evaluate wall motion and to quantify biventricular volumes and ejection fraction (EF). For MIO assessment, a T2* multislice approach was used. To detect myocardial fibrosis, late gadolinium enhanced (LGE) images were acquired. For the LV the 16-segment model of the AHA/ACC was taken into account during image analysis: wall motion, T2* value and presence/absence of enhancing area were evaluated for each segment. ResultsAbnormal motion of LV was found in 66 (6%) patients (60 hypokinetic and 6 dyskinetic). Table 1 shows the comparison between TM patients with normal and abnormal LV motion. Patients with abnormal LV motion were older and had significantly lower global T2* value and significantly higher number of segments with T2*<20 ms. Left volumes and mass indexed by body surface area were significantly higher in patients with abnormal LV motion while the EF was significantly lower. LGE areas were detected in 196 patients (18%) and were predominantly located in the mid-ventricular septum. There was a significant correlation between LGE and abnormal LV motion.Table 1Abnormal LV motionNormal LV motionPAge33.1 ± 8.330.4 ± 8.50.014Sex (M/F)37/29500/5260.248Global heart T2* (ms)22.5 ± 14.730.4 ± 8.50.001N. of segments with T2* < 20 ms8.6 ± 7.54.6 ± 6.1<0.0001Global heart T2* <20 ms, N (%)38 (57.6)376 (36.6)0.001LV end-diastolic volume index (ml/m2)99.0 ± 24.587.5 ± 18.9<0.0001LV end-systolic volume index (ml/m2)49.3 ± 18.734.0 ± 11.6<0.0001LV mass index (g/m2)66.3 ± 14.158.4 ± 13.3<0.0001LV ejection fraction (%)51.1 ± 9.161.7 ± 6.6<0.0001LGE, N (%)34 (51.5)162 (15.8)<0.0001Abnormal motion of the RV was found in 35 (3.2%) patients (29 hypokinetic, 5 dyskinetic and 1 akynetic). Table 2 shows the comparison between TM patients with normal and abnormal RV motion. Patients with abnormal RV motion were older and they were more frequently males. Right volumes were significantly higher in patients with abnormal RV motion while the EF was significantly lower.Table 2Abnormal RV motionNormal RV motionPAge33.9 ± 5.930.5 ± 8.60.013Sex (M/F)27/8510/5470.001RV end-diastolic volume index (ml/m2)110.4 ± 48.283.4 ± 19.2<0.0001RV end-systolic volume index (ml/m2)61.5 ± 29.632.5 ± 11.4<0.0001RV ejection fraction (%)44.9 ± 10.161.4 ± 7.7<0.0001Abnormal LV motion was not correlated with abnormal RV motion. Seventeen patients showed movement abnormalities in both ventricles. ConclusionsMovement abnormalities in the left ventricle were not really frequent in TM patients but were associated with age, MIO, LV dilation and dysfunction, and myocardial fibrosis. Movement abnormalities in the right ventricle were less frequent compared to the left ventricle, but were associated with age, sex , RV dilation and dysfunction. Disclosures:No relevant conflicts of interest to declare.