Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Patients
2.2. Magnetic Resonance Imaging
2.3. Biochemical Assays
2.4. Statistical Analysis
3. Results
3.1. Demographic and Clinical Characteristics of TI and TM Patients
3.2. Clinical Correlates of Tissue Iron Levels in TI and TM
3.3. Comparison of Tissue Iron Levels between TI and TM Patients
3.4. Clinical Correlates of Biventricular Function Parameters in TI and TM
3.5. Comparison of Biventricular Function Parameters between TI and TM Patients
3.6. Replacement Myocardial Fibrosis in TI and TM
4. Discussion
Study Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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TI Group (n = 135) | TM Group (n = 135) | p-Value | |
---|---|---|---|
Age (yrs) | 44.73 ± 12.16 | 43.35 ± 9.83 | 0.306 |
Females, n (%) | 77 (57.0) | 77 (57.0) | 1.000 |
Splenectomy, n (%) | 109 (80.7) | 104 (77.0) | 0.456 |
Age at splenectomy (years) | 16.29 ± 10.61 | 13.44 ± 8.17 | 0.124 |
Age at start of regular transfusions (years) | 19.19 ± 18.51 | 1.34 ± 1.51 | <0.0001 |
Duration of regular transfusions (years) | 25.15 ± 15.26 | 41.37 ± 9.62 | <0.0001 |
Patients in chelation therapy, n (%) | 130 (96.3) | 145 (100) | 0.060 |
Age at start of chelation therapy (years) | 17.76 ± 16.19 | 6.41 ± 5.98 | <0.0001 |
Mean pre-transfusion hemoglobin (g/dL) | 9.49 ± 0.58 | 9.72 ± 0.51 | 0.005 |
Mean serum ferritin (ng/mL) | 861.82 ± 947.34 | 762.79 ± 736.82 | 0.584 |
MRI LIC (mg/g dw) | 6.54 ± 14.68 | 5.22 ± 6.62 | 0.853 |
Hepatic iron overload, n (%) | 87 (64.4) | 90 (66.7) | 0.701 |
Global pancreas R2* (Hz) | 93.47 ± 93.23 | 148.38 ± 107.73 | <0.0001 |
Pancreatic iron overload, n (%) | 92 (68.1) | 127 (94.1) | <0.0001 |
Global heart R2* (Hz) | 26.19 ± 7.17 | 30.38 ± 16.57 | <0.0001 |
Significant myocardial iron overload, n (%) | 4 (3.0) | 7 (5.2) | 0.540 |
n. of segments with R2* > 50 Hz | 0.44 ± 2.04 | 1.24 ± 3.73 | 0.010 |
At least 1 segment with R2* > 50 Hz, n (%) | 13 (9.6) | 28 (20.7) | 0.011 |
LV EDVI (mL/m2) | 86.77 ± 16.57 | 81.36 ± 16.84 | 0.003 |
LV ESVI (mL/m2) | 33.17 ± 11.80 | 29.49 ± 10.29 | 0.006 |
LV mass index (g/m2) | 57.88 ± 13.28 | 54.63 ± 13.27 | 0.049 |
LV EF (%) | 62.89 ± 7.36 | 64.24 ± 7.10 | 0.129 |
RV EDVI (mL/m2) | 83.45 ± 17.49 | 78.96 ± 17.05 | 0.046 |
RV ESVI (mL/m2) | 31.27 ± 12.06 | 29.31 ± 10.34 | 0.253 |
RV EF (%) | 63.41 ± 8.15 | 62.61 ± 9.21 | 0.546 |
Wall motion abnormalities, n (%) | 11 (8.1) | 11 (8.1) | 1.000 |
Replacement myocardial fibrosis, n (%) | 10/42 (23.8) | 11/39 (28.2) | 0.652 |
TI Patients | TM Patients | |||||
---|---|---|---|---|---|---|
MRI LIC | Global Pancreas R2* | Global Heart R2* | MRI LIC | Global Pancreas R2* | Global Heart R2* | |
Categorical variables | Difference of MRI iron overload parameter between two groups (absent vs. present) | |||||
Female sex | 6.39 ± 19.54 vs. 6.65 ± 9.68 mg/g dw (p = 0.824) | 69.16 ± 76.26 vs. 111.47 ± 100.76 Hz (p = 0.011) | 25.44 ± 4.94 vs. 26.77 ± 8.46 Hz (p = 0.986) | 5.94 ± 7.29 vs. 4.68 ± 6.06 mg/g dw (p = 0.363) | 148.77 ± 100.35 vs. 148.08 ± 113.62 Hz (p = 0.922) | 28.97 ± 11.29 vs. 31.44 ± 19.64 Hz (p = 0.769) |
Splenectomy | 7.36 ± 10.70 vs. 6.34 ± 15.52 mg/g dw (p = 0.056) | 62.21 ± 70.92 vs. 100.99 ± 96.21 Hz (p = 0.004) | 24.71 ± 2.92 vs. 26.55 ± 7.82 Hz (p = 0.491) | 6.31 ± 7.26 vs. 4.90 ± 6.42 mg/g dw (p = 0.104) | 121.87 ± 91.78 vs. 154.19 ± 111.78 Hz (p = 0.150) | 28.37 ± 13.16 vs. 30.98 ± 17.47 Hz (p = 0.384) |
Continuous variables | Correlation (R, p-value) with MRI iron overload parameter | |||||
Age | R = −0.154, p = 0.075 | R = −0.158, p = 0.069 | R = −0.134, p = 0.121 | R = −0.135, p = 0.118 | R = 0.086, p = 0.321 | R = 0.035, p = 0.690 |
Duration of regular transfusions | R = −0.197, p = 0.085 | R = 0.253, p = 0.007 | R = −0.061, p = 0.518 | R= −0.144, p = 0.108 | R = 0.148, p = 0.100 | R = 0.057, p = 0.525 |
Pre-transfusion hemoglobin | R = −0.126, p = 0.200 | R = 0.004, p = 0.972 | R = 0.068, p = 0.491 | R = −0.165, p = 0.075 | R = −0.121, p = 0.095 | R = −0.004, p = 0.970 |
Mean serum ferritin | R = 0.707, p < 0.0001 | R = 0.148, p = 0.129 | R = 0.160, p = 0.102 | R = 0.650, p < 0.0001 | R = 0.085, p = 0.367 | R = 0.251, p = 0.007 |
MRI LIC | R = 0.253 p = 0.003 | R = 0.212 p = 0.014 | R = 0.167, p = 0.042 | R = 0.274, p = 0.001 | ||
Global pancreas R2* | R = 0.253 p = 0.003 | R = 0.306 p < 0.0001 | R = 0.167, p = 0.042 | R = 0.275, p = 0.001 | ||
Global heart R2* | R = 0.212 p = 0.014 | R = 0.306 p < 0.0001 | R = 0.274, p = 0.001 | R = 0.275, p = 0.001 |
LV EDVI | LV ESVI | LV Mass Index | LV EF | RV EDVI | RV ESVI | RV EF | |
---|---|---|---|---|---|---|---|
Categorical variables | Difference in biventricular parameters between two groups (absent vs. present) | ||||||
Female sex | 95.52 ± 16.09 vs. 80.18 ± 13.69 mL/m2 (p < 0.0001) | 38.45 ± 11.08 vs. 29.19 ± 10.79 mL/m2 (p < 0.0001) | 65.91 ± 13.47 vs. 51.83 ± 9.42 g/m2 (p < 0.0001) | 60.34 ± 7.78 vs. 64.82 ± 6.44 % (p < 0.0001) | 93.97 ± 17.18 vs. 75.54 ± 13.05 mL/m2 (p < 0.0001) | 38.54 ± 12.47 vs. 25.79 ± 8.31 mL/m2 (p < 0.0001) | 60.10 ± 7.24 vs. 65.91 ± 7.95 % (p < 0.0001) |
Splenectomy | 79.15 ± 13.75 vs. 88.59 ± 16.72 mL/m2 (p = 0.009) | 29.04 ± 9.37 vs. 34.16 ± 12.14 mL/m2 (p = 0.047) | 53.42 ± 15.71 vs. 58.95 ± 12.48 g/m2 (p = 0.144) | 63.46 ± 7.32 vs. 62.76 ± 7.39 % (p = 0.665) | 78.54 ± 17.64 vs. 84.63 ± 17.33 mL/m2 (p = 0.111) | 29.23 ± 12.35 vs. 31.75 ± 11.99 mL/m2 (p = 0.191 | 65.35 ± 8.27 vs. 62.95 ± 8.09 % (p = 0.337) |
Continuous variables | Correlation (R, p-value) with biventricular function parameter | ||||||
Age | R = −0.310, p < 0.0001 | R = −0.279, p = 0.001 | R = −0.191, p = 0.027 | R = 0.211, p = 0.014 | R = −0.250, p = 0.003 | R = −0.231, p = 0.007 | R = 0.178, p = 0.039 |
Duration of regular transfusions | R = −0.211, p = 0.023 | R = −0.124, p = 0.187 | R = −0.031, p = 0.741 | R = −0.023, p = 0.806 | R = −0.111, p = 0.236 | R = −0.017, p = 0.854 | R = −0.115, p = 0.220 |
Pre-transfusion hemoglobin | R = −0.026, p = 0.795 | R = 0.034, p = 0.728 | R = 0.036, p = 0.714 | R = −0.084, p = 0.391 | R = 0.015, p = 0.882 | R = 0.027, p = 0.780 | R = −0.103, p = 0.293 |
Mean serum ferritin | R = 0.008, p = 0.936 | R = 0.051, p = 0.601 | R = 0.112, p = 0.253 | R = −0.116, p = 0.236 | R = −0.046, p = 0.636 | R = −0.025, p = 0.801 | R = 0.018, p = 0.857 |
MRI LIC | R = 0.043, p = 0.617 | R = 0.027, p = 0.754 | R = 0.105, p = 0.225 | R = −0.023, p = 0.794 | R = 0.074, p = 0.394 | R = 0.061, p = 0.480 | R = −0.018, p = 0.834 |
Global pancreas R2* | R = −0.081, p = 0.335 | R = −0.116, p = 0.183 | R = −0.079, p = 0.362 | R = 0.121, p = 0.165 | R = −0.040, p = 0.647 | R = −0.072, p = 0.410 | R = 0.065, p = 0.457 |
Global heart R2* | R = −0.006, p = 0.948 | R = −0.042, p = 0.625 | R = −0.036, p = 0.679 | R = 0.090, p = 0.298 | R = −0.052, p = 0.550 | R = −0.098, p = 0.258 | R = 0.165, p = 0.055 |
LV EDVI | LV ESVI | LV Mass Index | LV EF | RV EDVI | RV ESVI | RV EF | |
---|---|---|---|---|---|---|---|
Categorical variables | Difference in biventricular parameters between two groups (absent vs. present) | ||||||
Female sex | 92.02 ± 16.66 vs. 73.34 ± 11.84 mL/m2 (p < 0.0001) | 35.55 ± 10.19 vs. 24.92 ± 7.71 mL/m2 (p < 0.0001) | 62.07 ± 12.92 vs. 49.03 ± 10.54 g/m2 (p < 0.0001) | 61.76 ± 5.94 vs. 66.10 ± 7.37 % (p < 0.0001) | 89.66 ± 15.09 vs. 70.91 ± 13.74 mL/m2 (p < 0.0001) | 34.76 ± 10.28 vs. 25.19 ± 8.32 mL/m2 (p < 0.0001) | 61.22 ± 7.46 vs. 63.66 ± 10.26 % (p = 0.012) |
Splenectomy | 80.55 ± 16.86 vs. 81.61 ± 16.91 mL/m2 (p = 0.761) | 29.36 ± 9.90 vs. 29.53 ± 10.44 mL/m2 (p = 0.981) | 50.77 ± 13.19 vs. 55.78 ± 13.14 g/m2 (p = 0.102) | 63.84 ± 7.12 vs. 64.36 ± 7.13 % (p = 0.723) | 77.00 ± 17.52 vs. 79.55 ± 16.95 mL/m2 (p = 0.467) | 29.94 ± 11.55 vs. 29.13 ± 10.01 mL/m2 (p = 0.908) | 62.19 ± 8.60 vs. 62.74 ± 9.42 % (p = 0.773) |
Continuous variables | Correlation (R, p-value) with biventricular function parameter | ||||||
Age | R = −0.289, p = 0.001 | R = −0.298, p < 0.0001 | R = −0.044, p = 0.614 | R = 0.223, p = 0.009 | R = −0.363, p < 0.0001 | R = −0.336, p < 0.0001 | R = 0.177, p = 0.040 |
Duration of regular transfusions | R = −0.320, p < 0.0001 | R = −0.342, p < 0.0001 | R = −0.048, p = 0.597 | R = 0.272, p = 0.002 | R = −0.384, p < 0.0001 | R = −0.357, p < 0.0001 | R = 0.185, p = 0.039 |
Pre-transfusion hemoglobin | R = −0.181, p = 0.051 | R = −0.107, p = 0.250 | R = 0.035, p = 0.706 | R = 0.003, p = 0.977 | R = −0.105, p = 0.261 | R = −0.072, p = 0.439 | R = 0.030, p = 0.748 |
Mean serum ferritin | R = 0.010, p = 0.917 | R = 0.105, p = 0.263 | R = 0.076, p = 0.415 | R = −0.202, p = 0.080 | R = −0.070, p = 0.455 | R = 0.091, p = 0.331 | R = −0.067, p = 0.476 |
MRI LIC | R = 0.134, p = 0.121 | R = 0.173, p = 0.055 | R = 0.134, p = 0.120 | R = −0.200, p = 0.060 | R = 0.084, p = 0.333 | R = 0.109, p = 0.207 | R = −0.064, p = 0.458 |
Global pancreas R2* | R = −0.067, p = 0.438 | R = −0.044, p = 0.615 | R = 0.032, p = 0.709 | R = 0.054, p = 0.536 | R = −0.064, p = 0.464 | R = −0.089, p = 0.306 | R = −0.017, p = 0.844 |
Global heart R2* | R = −0.068, p = 0.432 | R = −0.090, p = 0.298 | R = −0.081, p = 0.352 | R = 0.101, p = 0.245 | R = −0.066, p = 0.445 | R = −0.164, p = 0.057 | R = 0.148, p = 0.086 |
TI Patients | TM Patients | |||||
---|---|---|---|---|---|---|
No LGE (n = 32) | LGE (n = 10) | p-Value | No LGE (n = 28) | LGE (n = 11) | p-Value | |
Age (yrs) | 43.71 ± 11.11 | 50.63 ± 7.54 | 0.035 | 41.62 ± 8.31 | 51.41 ± 8.27 | 0.002 |
Females, n (%) | 17 (53.1) | 8 (80.0) | 0.162 | 15 (53.6) | 7 (63.6) | 0.725 |
Splenectomy, n (%) | 25 (78.1) | 9 (90.0) | 0.655 | 7 (75.0) | 11 (100.0) | 0.159 |
Duration of regular transfusions (years) | 26.29 ± 15.36 | 21.09 ± 12.24 | 0.372 | 39.88 ± 8.05 | 49.24 ± 8.26 | 0.003 |
Patients in chelation therapy, n (%) | 31 (96.9) | 10 (100.0) | 0.572 | 28 (100.0) | 11 (100.0) | - |
Mean pre-transfusion hemoglobin (g/dL) | 9.46 ± 0.57 | 9.56 ± 0.43 | 0.810 | 9.82 ± 0.54 | 9.82 ± 0.49 | 0.773 |
Mean serum ferritin (ng/mL) | 971.33 ± 1130.75 | 625.25 ± 553.49 | 0.408 | 1134.68 ± 1028.42 | 837.45 ± 947.53 | 0.117 |
MRI LIC (mg/g dw) | 6.29 ± 9.75 | 5.98 ± 8.73 | 0.555 | 5.38 ± 7.11 | 4.60 ± 3.58 | 0.685 |
Global pancreas R2* (Hz) | 75.55 ± 80.61 | 133.15 ± 105.99 | 0.140 | 165.22 ± 146.02 | 199.63 ± 136.23 | 0.224 |
Global heart R2* (Hz) | 25.70 ± 6.15 | 24.38 ± 1.83 | 0.779 | 31.58 ± 17.60 | 27.25 ± 6.27 | 0.827 |
LV EDVI (mL/m2) | 85.28 ± 18.05 | 80.80 ± 11.24 | 0.465 | 83.00 ± 16.54 | 84.36 ± 20.78 | 0.950 |
LV ESVI (mL/m2) | 34.06 ± 12.41 | 30.30 ± 10.32 | 0.425 | 29.25 ± 9.00 | 34.55 ± 13.41 | 0.217 |
LV mass index (g/m2) | 61.19 ± 14.95 | 58.50 ± 6.65 | 0.658 | 58.00 ± 14.75 | 59.09 ± 11.21 | 0.876 |
LV EF (%) | 62.22 ± 8.26 | 62.60 ± 8.09 | 0.899 | 64.71 ± 6.02 | 58.82 ± 9.09 | 0.055 |
RV EDVI (mL/m2) | 84.41 ± 11.17 | 75.80 ± 11.08 | 0.136 | 82.64 ± 15.57 | 81.36 ± 24.73 | 0.743 |
RV ESVI (mL/m2) | 32.59 ± 10.39 | 27.90 ± 11.59 | 0.147 | 31.29 ± 9.97 | 35.09 ± 14.40 | 0.673 |
RV EF (%) | 61.91 ± 7.05 | 63.40 ± 9.79 | 0.598 | 62.14 ± 6.61 | 56.64 ± 8.20 | 0.057 |
Wall motion abnormalities, n (%) | 1 (3.1) | 1 (10.0) | 0.424 | 0 (0.0) | 3 (27.3) | 0.018 |
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Meloni, A.; Pistoia, L.; Ricchi, P.; Longo, F.; Cecinati, V.; Sorrentino, F.; Borsellino, Z.; Bagnato, S.; Rossi, V.; Fina, P.; et al. Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients. J. Clin. Med. 2024, 13, 4791. https://doi.org/10.3390/jcm13164791
Meloni A, Pistoia L, Ricchi P, Longo F, Cecinati V, Sorrentino F, Borsellino Z, Bagnato S, Rossi V, Fina P, et al. Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients. Journal of Clinical Medicine. 2024; 13(16):4791. https://doi.org/10.3390/jcm13164791
Chicago/Turabian StyleMeloni, Antonella, Laura Pistoia, Paolo Ricchi, Filomena Longo, Valerio Cecinati, Francesco Sorrentino, Zelia Borsellino, Sergio Bagnato, Vincenza Rossi, Priscilla Fina, and et al. 2024. "Magnetic Resonance Evaluation of Tissue Iron Deposition and Cardiac Function in Adult Regularly Transfused Thalassemia Intermedia Compared with Thalassemia Major Patients" Journal of Clinical Medicine 13, no. 16: 4791. https://doi.org/10.3390/jcm13164791