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Cardiac Magnetic Resonance for the Evaluation of Suspected Cardiac Thrombus: Conventional and Emerging Techniques
Published on: June 11, 2019
Multiparametric Cardiac Magnetic Resonance Assessment in Sickle Beta Thalassemia
Laura Pistoia1,2, Antonella Meloni2,3, Vincenzo Positano2,3
1Unità Operativa Complessa Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy.
Insights
Cardiac function in sickle beta thalassemia patients is similar to sickle cell anemia patients but differs from healthy individuals. New reference values for cardiac parameters in sickle beta thalassemia are needed.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Cardiac involvement in sickle beta thalassemia (Sβ-thal) is understudied.
- Cardiovascular magnetic resonance (CMR) is crucial for assessing cardiac function and iron overload.
Purpose of the Study:
- To evaluate cardiac function and myocardial iron overload in Sβ-thal patients using CMR.
- To compare cardiac parameters between Sβ-thal, sickle cell anemia (SCA), and healthy individuals.
Main Methods:
- 111 Sβ-thal patients, 46 SCA patients, and 111 healthy volunteers were studied.
- CMR assessed biventricular function, myocardial iron overload (T2*), and fibrosis (LGE).
Main Results:
- Sβ-thal and SCA patients showed similar cardiac morphology, function, iron overload, and fibrosis.
- Sβ-thal patients had altered bi-atrial and biventricular parameters compared to healthy subjects, with lower LV ejection fraction.
- SCA patients had higher left atrial area and LV stroke volume index than Sβ-thal patients.
Conclusions:
- CMR analysis confirms phenotypic similarity between Sβ-thal and SCA patients.
- Sβ-thal patients exhibit significant cardiac morphological and functional differences from healthy individuals.
- Establishing Sβ-thal/SCA-specific reference values for cardiac parameters is recommended.
Abstract:
Cardiac involvement in sickle beta thalassemia (Sβ-thal) patients has been poorly investigated. We aimed to evaluate cardiac function and myocardial iron overload by cardiovascular magnetic resonance (CMR) in patients with Sβ-thal. One-hundred and eleven Sβ-thal patients consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network were studied and compared with 46 sickle cell anemia (SCA) patients and with 111 gender- and age- matched healthy volunteers. Cine images were acquired to quantify biventricular function. Myocardial iron overload (MIO) was assessed by the T2* technique, while macroscopic myocardial fibrosis was evaluated by the late gadolinium enhancement (LGE) technique. In Sβ-thal and SCA patients, the morphological and functional CMR parameters were not significantly different, except for the left atrial area and left ventricular (LV) stroke volume, indexed by body surface area (p = 0.023 and p = 0.048, respectively), which were significantly higher in SCA patients. No significant differences between the two groups were found in terms of myocardial iron overload and macroscopic myocardial fibrosis. When compared to healthy subjects, Sβ-thal patients showed significantly higher bi-atrial and biventricular parameters, except for LV ejection fraction, which was significantly lower. The CMR analysis confirmed that Sβ-thal and SCA patients are phenotypically similar. Since Sβ-thal patients showed markedly different morphological and functional indices from healthy subjects, it would be useful to identify Sβ-thal/SCA-specific bi-atrial and biventricular reference values.
