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Published on: June 21, 2016
Correlation of echocardiography parameters with cardiac magnetic resonance imaging in transfusion-dependent
Athanassios Aessopos1, Anastasios Giakoumis, Christina Fragodimitri
1First Department of Medicine, University of Athens, Laiko General Hospital, Athens, Greece. aaisopos@cc.uoa.gr
Insights
Echocardiography (Echo) has limited value in predicting heart iron overload, but certain parameters may aid monitoring. Patients with decreased left ventricular function should be presumed to have iron overload and receive intensified chelation therapy.
Area of Science:
- Cardiology
- Medical Imaging
- Hematology
Background:
- Cardiac iron (Fe) overload is a serious complication in conditions like thalassaemia major.
- Cardiac magnetic resonance (CMR) T2* is the gold standard for quantifying cardiac Fe but has limited accessibility.
- Echocardiography (Echo) is a widely available and cost-effective imaging modality.
Purpose of the Study:
- To evaluate the utility of echocardiography (Echo) parameters in predicting cardiac iron (Fe) load.
- To identify accessible imaging markers for cardiac Fe assessment in resource-limited settings.
Main Methods:
- A comparative study involving 142 thalassaemia major patients who underwent both Echo and CMR.
- Analysis of various Echo-derived parameters against cardiac Fe levels determined by CMR T2*.
Main Results:
- Patients with decreased left ventricular (LV) systolic function invariably had cardiac Fe.
- Specific Echo parameters (e.g., Tdi >5.57 cms/m2, LA index >2.41 cm/m2, E/A > 1.96) showed high specificity but low sensitivity for predicting iron load.
- Other Echo indices (e.g., RV index >1.47 cm/m2, LV systolic index >2.26 cm/m2) differentiated moderate from heavy iron loads with high specificity but low sensitivity.
Conclusions:
- Echocardiography parameters have restricted value for primary prediction of cardiac Fe.
- CMR remains essential for accurate cardiac Fe assessment.
- Patients with reduced LV systolic function or specific Echo criteria should be considered to have cardiac Fe, warranting intensified chelation therapy.
- Echo parameters may be useful for ongoing monitoring of cardiac Fe once diagnosed by CMR.
Background And Objective:
Heart iron load (cardiac Fe) can be indirectly quantified by cardiac magnetic resonance (CMR) T2*. CMR accessibility is limited, whereas echocardiography (Echo) is relatively inexpensive and readily available. The objective was to find Echo parameters that may be useful for predicting cardiac Fe.
Design And Methods:
We compared a number of parameters derived from Echo to cardiac Fe in 142 thalassaemia major patients who had undergone a CMR study.
Results:
All patients with decreased left ventricular (LV) function had cardiac Fe. After removing those patients from the analysis, the total diameter index (Tdi) >5.57 cms/m2, left atrial diameter index >2.41 cm/m2, and the diastolic parameter E/A > 1.96 were highly specific (91.4%, 97.1% and 96.9% respectively) but had low sensitivity (31.8%, 20.45% and 21.8%) in predicting iron load. A right ventricular index >1.47 cm/m2, LV systolic index >2.26 cm/m2 or Tdi >6.26 cm/m2 discriminated between patients with no, or mild to moderate cardiac Fe from those with heavy load, with specificity of 91%, 98.5%, and 98.5%, respectively, but with low sensitivity.
Interpretation And Conclusions:
Echo parameters for cardiac Fe prediction have restricted value, whereas CMR is essential to assess cardiac Fe. However, patients with decreased LV systolic function should be considered a priori as having cardiac Fe, and chelation therapy should be intensified. This also applies to patients who have the above-described Echo criterion values, even if CMR is not available. Once a patient is found by CMR to have cardiac Fe, then the above Echo criterion values may be useful for ongoing monitoring.
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