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Estimation of cardiac left ventricular ejection fraction in transfusional cardiac iron overload by R2* magnetic
Juri Sakuta1, Yoshikazu Ito, Yukihiko Kimura
1First Department of Internal Medicine (Division of Hematology), Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
Insights
Transfusional iron overload can cause cardiac dysfunction in patients needing blood transfusions. This study suggests specific ferritin and red blood cell transfusion levels may predict future heart problems.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Transfusional iron overload is a serious complication for patients with hematological disorders requiring regular blood transfusions.
- Cardiac dysfunction is a critical concern, necessitating effective monitoring and management strategies.
Purpose of the Study:
- To investigate the relationship between iron overload markers and cardiac function in transfusion-dependent patients.
- To propose predictive formulas for cardiac dysfunction using established clinical parameters.
Main Methods:
- Utilized MRI-T2* and MRI-R2* values, and left ventricular ejection fraction in 19 adult patients.
- Analyzed correlations between R2* values, serum ferritin levels, and total red blood cell transfusion units.
- Examined subgroups based on T2* values to assess parameter influence.
Main Results:
- Found a significant positive correlation between R2* values and serum ferritin (r=0.81) and total RBC transfusion volume (r=0.90).
- Correlation weakened in patients with T2* values over 30 ms.
- Derived formulas suggesting ~50 Japanese units or 2,900 pmol/L ferritin as potential cutoff values for cardiac dysfunction risk.
Conclusions:
- Serum ferritin and RBC transfusion volume are key indicators of cardiac iron loading.
- Proposed cutoff values may help identify patients at risk of future cardiac dysfunction, guiding iron chelation therapy initiation.
Abstract:
Cardiac dysfunction due to transfusional iron overload is one of the most critical complications for patients with transfusion-dependent hematological disorders. Clinical parameters such as total red blood cell (RBC) transfusion units and serum ferritin level are usually considered as indicators for initiation of iron chelation therapy. We used MRI-T2*, MRI-R2* values, and left ventricular ejection fraction in 19 adult patients with blood transfusion-dependent hematological disorders without consecutive oral iron chelation therapy, and propose possible formulae of cardiac function using known parameters, such as total RBC transfusion units and serum ferritin levels. We found a positive correlation in all patients between both R2* values (reciprocal values of T2*) and serum ferritin levels (r = 0.81) and also total RBC transfusion volume (r = 0.90), but not when we analyzed subgroups of patients whose T2* values were over 30 ms (0.52). From the formulae of the R2*, we concluded that approximately 50 Japanese units or 2,900 pmol/L ferritin might be the cutoff value indicating possible future cardiac dysfunction.
