Cardiovascular magnetic resonance in β-thalassemia major: beyond T2

Area of Science:

• Cardiology
• Hematology
• Radiology

Background:

• Beta-thalassemia major (TM) necessitates regular blood transfusions, leading to iron overload.
• Myocardial iron accumulation in TM patients causes cardiac dysfunction and heart failure.
• Current diagnostic methods for cardiac dysfunction in TM have limitations.

Purpose of the Study:

• To review the established and emerging roles of Cardiac Magnetic Resonance (CMR) in managing beta-thalassemia major.
• To highlight advanced CMR techniques beyond T2* for improved diagnosis and prognosis.

Main Methods:

• Review of current literature on CMR applications in beta-thalassemia major.
• Focus on T2* relaxation time for myocardial iron assessment.
• Exploration of advanced CMR techniques: myocardial strain, parametric mapping (T1, T2, ECV), and late gadolinium enhancement (LGE).

Main Results:

• T2* measurement is the gold standard for assessing myocardial iron overload and guiding chelation therapy.
• Despite therapy, heart failure remains a major cause of mortality in TM.
• Advanced CMR biomarkers show potential for enhanced diagnosis, prognosis, and patient follow-up.

Conclusions:

• CMR, particularly T2* imaging, is crucial for managing iron overload in beta-thalassemia major.
• Emerging CMR biomarkers offer expanded capabilities for comprehensive patient management.
• Further research into advanced CMR applications may significantly improve outcomes for TM patients.