Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major

Circulation. 2009 Nov 17;120(20):1961-8. doi: 10.1161/CIRCULATIONAHA.109.874487. Epub 2009 Oct 2.

Abstract

Background: The goal of this study was to determine the predictive value of cardiac T2* magnetic resonance for heart failure and arrhythmia in thalassemia major.

Methods and results: We analyzed cardiac and liver T2* magnetic resonance and serum ferritin in 652 thalassemia major patients from 21 UK centers with 1442 magnetic resonance scans. The relative risk for heart failure with cardiac T2* values <10 ms (compared with >10 ms) was 160 (95% confidence interval, 39 to 653). Heart failure occurred in 47% of patients within 1 year of a cardiac T2* <6 ms with a relative risk of 270 (95% confidence interval, 64 to 1129). The area under the receiver-operating characteristic curve for predicting heart failure was significantly greater for cardiac T2* (0.948) than for liver T2* (0.589; P<0.001) or serum ferritin (0.629; P<0.001). Cardiac T2* was <10 ms in 98% of scans in patients who developed heart failure. The relative risk for arrhythmia with cardiac T2* values <20 ms (compared with >20 ms) was 4.6 (95% confidence interval, 2.66 to 7.95). Arrhythmia occurred in 14% of patients within 1 year of a cardiac T2* of <6 ms. The area under the receiver-operating characteristic curve for predicting arrhythmia was significantly greater for cardiac T2* (0.747) than for liver T2* (0.514; P<0.001) or serum ferritin (0.518; P<0.001). The cardiac T2* was <20 ms in 83% of scans in patients who developed arrhythmia.

Conclusions: Cardiac T2* magnetic resonance identifies patients at high risk of heart failure and arrhythmia from myocardial siderosis in thalassemia major and is superior to serum ferritin and liver iron. Using cardiac T2* for the early identification and treatment of patients at risk is a logical means of reducing the high burden of cardiac mortality in myocardial siderosis. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00520559.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Arrhythmias, Cardiac / blood
  • Arrhythmias, Cardiac / diagnostic imaging*
  • Arrhythmias, Cardiac / epidemiology
  • Arrhythmias, Cardiac / etiology
  • Female
  • Ferritins / blood
  • Follow-Up Studies
  • Heart Failure / blood
  • Heart Failure / diagnostic imaging*
  • Heart Failure / epidemiology
  • Heart Failure / etiology
  • Hemosiderosis / blood
  • Hemosiderosis / diagnostic imaging
  • Hemosiderosis / epidemiology
  • Humans
  • Iron / metabolism
  • Liver / diagnostic imaging
  • Liver / metabolism
  • Magnetic Resonance Imaging*
  • Male
  • Predictive Value of Tests
  • Radiography
  • Retrospective Studies
  • Risk Factors
  • United Kingdom / epidemiology
  • beta-Thalassemia / blood
  • beta-Thalassemia / complications
  • beta-Thalassemia / diagnostic imaging*
  • beta-Thalassemia / epidemiology

Substances

  • Ferritins
  • Iron

Associated data

  • ClinicalTrials.gov/NCT00520559