Assessment of cardiac iron overload in multiply transfused thalassemic children using T2* weighted cardiac magnetic resonance

Abstract

Background: Cardiac failure secondary to transfusional iron overload is the most common cause of death in patients with thalassemia. Early detection of myocardial iron deposition is necessary to prevent overt heart failure. Objective: Assessment of myocardial and hepatic iron deposition by T2* weighted magnetic resonance (MR). Materials and Methods: A total of 32 transfusion dependent thalassemic children were enrolled in a cross-sectional study conducted at thalassemia center in a teaching hospital. Gradient echo T2* MR was done in all patients for the assessment of myocardial and hepatic iron deposition. Results: Out of these 32 thalassemic patients studied, 21 (65.6%)were males and 11 (34.4%)were females. The mean age of the enrolled patients was 14.6 years (range 9-24 years). Out of 32 patients studied, cardiac iron deposition (cardiac T2* <20 ms)was present in 14 (43.8%)patients and was absent (cardiac T2* >20 ms)in the remaining 18 (56.3%)patients.
The hepatic iron deposition was assessed by T2* MR in 31/32 patients. None of the patients had normal liver iron (hepatic T2* - more than 6.3 ms). Out of those 31 patients, 1 (3.2%)patients had mild (hepatic T2* - 6.3-2.7 ms), 17 (54.83%)patients had moderate (hepatic T2* - 2.7-1.4 ms), and 13 (41.93%)patients had severe (hepatic T2* - <1.4 ms)hepatic iron deposition. No significant correlation could be found between hepatic and cardiac T2* (p=0.415, Cramer’s V 0.313). The mean serum ferritin was 5202 ng/ml. No significant association was
found between cardiac T2* and serum ferritin levels (p=0.270, Cramer’s V 0.350). Conclusion: There is no significant correlation between hepatic and cardiac iron deposition. Similarly, no correlation was seen between cardiac iron deposition and serum ferritin levels.