Role of Cardiovascular Magnetic Resonance Imaging in Assessment of Myocardial Iron Overload in Thalassemic Patients

Abstract

Background: Thalassemia major anemia patients require repeated blood transfusions, which improves their survival and quality of life, however it leads to iron overload and cellular damage. Serum ferritin and liver biopsy were used classically to measure iron overload and to monitor patient response to chelation therapy. Magnetic resonance imaging (MRI T2*) has proven to be a non-invasive, effective technique in detecting and quantifying iron in the heart and liver and in adjustment of iron chelation therapy. Objective: To assess myocardial siderosis among our patients using MRI T2* technique and correlate it with hepatic iron load and left ventricular ejection fraction (LVEF). Patients and methods: Our study included 42 cases of monthly transfused patients. Hepatic and myocardial iron overload were measured by multi-breath-hold MRI T2* technique and a cine view sequence was used to assess left ventricular function (EF). Results: Myocardial and hepatic iron overload were inter-correlated to each other and correlated to left ventricular function (LVEF). There was insignificant correlation between cardiac and hepatic T2* value results (k = 0.014, P > 0.05). However, there was a progressive and significant decline in left ventricular ejection fraction (r = 0·61, P < 0·001) in patients with low cardiac T2* values (T2* < 20 ms). Conclusion: MRI T2* technique is a precise, reproducible, and non-invasive technique for measuring tissue iron concentration and sparing the patients from an invasive biopsy technique. It also benefits in early detection of cardiac dysfunction and provides a follow up tool helping in chelation therapy adjustment.