Publication: Cardiac iron overload in thalassaemia major patients with various chelation therapy using cardiac magnetic resonance (CMR T2*) value: A study in Hospital Seberang Jaya, Pulau Pinang
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Date
2021
Authors
Krishinan, Jegdiswary
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Abstract
Introduction: Thalassaemia is the most common inherited blood disorder in Malaysia. Beta thalassaemia major is caused by impaired synthesis of the beta globin chain producing fragile erythrocytes and haemolytic anaemia. Lifelong blood transfusion leads to iron overload and toxicity. Cardiac involvement in TM patients, mainly characterised by left ventricular dysfunction due to iron over load. Cardiac magnetic resonance (CMR) T2* value is being used for quantitative evaluation of cardiac iron in recent years, for earlier detection of cardiac iron overload and helps to optimise chelation therapy for TM patients. To date the correlation between cardiac iron T2* value and left ventricular ejection fraction (LVEF) and types of chelation therapy is poorly defined in our population. Therefore this study was conducted to analyse the correlation between cardiac iron T2* with LVEF and types of chelation therapy. Patients and methods: A cross sectional study was performed based on retrospective record review of TM patients who came for yearly cardiac iron surveillance in Radiology Department Hospital Seberang Jaya (HSJ) , Pulau Pinang. Myocardial iron load was assessed using T2* value which was classified as none, mild, moderate and severe. The LVEF was assessed by area length ejection fraction (ALEF) method using long axis horizontal view. The proportion of cardiac iron value and its severity were presented as descriptive analysis. Pearson correlation was used to analyse the correlation between T2* value and LVEF. Paired t-test was used for comparison of mean value of T2* and LVEF between the baseline and the 24th month. P value of less than 0.05 was considered statistically significant. Results: There were 150 patients in this study with mean age of 17.25 (± 7.20) years. Majority of them were males (n= 78, 52%) and mostly Malays (n = 122, 81.3%). Among this, 35 (23.3%) patients had cardiac iron overload CMR T2* <20 msec at baseline. Significant improvement seen in the mean cardiac T2* value of the cardiac iron overload patients, from 12.49 ± 4.93 msec at baseline to 15.51± 8.76 msec at 24th month (p value of 0.015). The mean LVEF of patients with cardiac iron overload was 58.91± 3.45% at baseline which also showed significant improvement at 24th month, 61.11 ± 5.49% (p value 0.015). There was significant correlation noted between T2* value and LVEF of all patients with cardiac iron overload with p value < 0.05. No significant association seen between the types of chelation therapy (single or combination) with the cardiac T2* value in patient with cardiac siderosis (p value >0.05). Conclusion: Our study showed there was significant improvement of cardiac T2* and LVEF value in thalassaemia major patients cardiac siderosis with significant correlation seen between the cardiac iron T2* value and LVEF. No significant association was noted with the cardiac iron T2* value and types of chelation therapy.
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Keywords
Cardiac Magnetic Resonance , Cardiac siderosis