Pancreatic exocrine function and cardiac iron in patients with iron overload and with thalassemia

Area of Science:

• Cardiology
• Biochemistry
• Radiology

Background:

• Cardiac iron overload is a significant risk in β-thalassemia major patients.
• Magnetic resonance imaging (MRI) is the gold standard for measuring cardiac iron but has limited accessibility.
• Identifying at-risk patients is crucial for timely intervention.

Purpose of the Study:

• To evaluate pancreatic exocrine function parameters as non-invasive markers for cardiac iron overload in β-thalassemia major.
• To correlate pancreatic lipase and amylase levels with cardiac iron levels measured by MRI-R2*.

Main Methods:

• 44 patients with β-thalassemia major underwent measurements of heart iron (MRI-R2*), liver iron (biomagnetic liver susceptometry), and pancreatic exocrine function (serum amylase and lipase).
• Receiver Operating Characteristic (ROC) analysis was used to determine the diagnostic accuracy of pancreatic function tests for detecting cardiac iron overload (defined as MRI-R2* > 50 sec⁻¹ or T2* < 20 msec).

Main Results:

• ROC analysis showed an area of 0.88 for detecting cardiac iron overload using lipase levels.
• A lipase cut-off level of 19 U/L was identified as indicative of elevated cardiac iron.
• Pancreatic amylase and lipase function parameters showed potential in identifying patients with cardiac iron overload.

Conclusions:

• Exocrine pancreatic lipase and amylase function tests can serve as valuable screening tools to identify patients with β-thalassemia major at risk of elevated cardiac iron levels.
• These non-invasive tests can help prioritize patients for cardiac MRI, especially in resource-limited settings.
• Further validation is warranted to integrate these markers into clinical practice for managing iron overload in thalassemia.