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      How does iron deposition modify the myocardium? A feature-tracking cardiac magnetic resonance study.

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          Iron-overload cardiomyopathy is the principal cause of mortality in thalassemia. Via feature-tracking cardiac magnetic resonance (FT-CMR), we investigated alterations in cardiac deformation with the progression in myocardial iron overload (MIO). We enrolled 154 patients with thalassemia (50.64% male, mean age = 32.19 ± 9.79 years) referred for MIO assessment and 28 controls (50% male, mean age = 31.07 ± 4.35 years). Functional, strain, and T2* values were assessed in 4 study groups: no MIO (T2* > 20), mild-to-moderate MIO (T2* = 10-20), severe MIO (T2* < 10), and healthy controls. The recorded strain values were compared between the groups. The study groups were statistically significantly different vis-à-vis left ventricular (LV) global longitudinal strain (GLS) (F [3, 178] = 20.30), LV global radial strain (GRS) (F [3, 178] = 11.61), right ventricular (RV) GLS (F [3, 178]) = 5.32), RV global circumferential strain (GCS) (F [3, 178] = 26.02), and RVGRS (F [3, 178] = 16.86) (Ps < 0.005). The post hoc test revealed that LVGLS, RVGCS, and RVGRS were different between patients with thalassemia but without MIO and the control group (Ps < 0.001). A significant difference in LVGLS and LVGRS was detected between the T2* > 20 and 10 ≤ T2* ≤ 20 groups (Ps < 0.05). The multivariate logistic regression analysis depicted LVGRS as the most robust predictor of MIO (T2* ≤ 20) (odds ratio = 0.920, 95% CI 0.886 to 0.955), which predicted MIO with a cutoff point of 31.16% or less (sensitivity = 62% and specificity = 80.77%). Biventricular FT-CMR values are impaired in patients with thalassemia even without MIO. With MIO progression, LV strain values are the first ones to be undermined. Notably, functional CMR indices are jeopardized late, only after severe iron deposition.

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          Author and article information

          Int J Cardiovasc Imaging
          The international journal of cardiovascular imaging
          Springer Science and Business Media LLC
          Nov 2021
          : 37
          : 11
          [1 ] Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
          [2 ] Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran. nahid6069@yahoo.com.
          [3 ] North Khorasan University of Medical Sciences, Bojnurd, Iran.
          [4 ] Iran University of Medical Sciences, Tehran, Iran.
          [5 ] Trauma Research Center, Rajaee (Emtiaz) Trauma Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, Chamran Boulevard, Shiraz, Iran.
          © 2021. The Author(s), under exclusive licence to Springer Nature B.V.

          Cardiac magnetic resonance (CMR),Feature tracking (FT),Myocardial iron overload (MIO),Thalassemia


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