ISMRM - SCMR Workshop
Antonella Meloni, PhD
Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana, Italy
Antonella Meloni, PhD
Biomedical Engineer
Fondazione G. Monasterio CNR Regione Toscana, Italy
Vincenzo Positano, MSc
Biomedical Engineer
Fondazione Toscana Gabriele Monasterio, Italy
Laura Pistoia, MSc
Biologist
Fondazione Toscana Gabriele Monasterio, Italy
Alessandra Campanella, MD
Radiologist
Azienda Ospedaliero-Universitaria di Cagliari - Polo di Monserrato, Italy
Stefania Renne, MD
Cardiologist
Presidio Ospedaliero “Giovanni Paolo II”, Italy
Sabrina Bagnato, MD
Hematologist
Presidio Ospedaliero Lentini - ASP 8 Siracusa, Italy
Stefano Pulini, MD
Hematologist
Ospedale Civile “Spirito Santo”, Italy
Piera Giovangrossi, MD
Hematologist
Ospedale S. M. Goretti, Italy
Luciana Rigoli, MD
Policlinico "G. Martino", Italy
Gianni Novani, RT
radiology technician
Fondazione G. Monasterio CNR-Regione Toscana, Italy
Filippo Cademartiri, MD, PhD
Radiologist
Fondazione Toscana Gabriele Monasterio, Italy
Riccardo Cau
Radiologist
Azienda Ospedaliero-Universitaria di Cagliari, Italy
Cardiac complications represent the primary cause of morbidity and mortality among β-thalassemia major (TM) patients. The dentification of early imaging biomarkers of cardiac involvement is undoubtedly valuable in clinical practice.
The aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with cardiac complications (heart failure and arrhythmias) in patients with β-TM.
Methods:
We considered 266 β-TM patients (134 females, 37.08±11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, and the T2* technique for the assessment of myocardial iron overload.
Results:
Twenty-two (8.3%) patients had at least one cardiac complication: 9 heart failure and 13 arrhythmias (76.9% supraventricular arrhythmias).
Patients without and with cardiac complications had no significant differences in global heart T2* values (35.89±11.07 ms vs. 34.09±11.32 ms; p=0.222), LV GCS (-14.82±2.65 % vs. -13.89±3.39 %; p=0.213), LV GRS (22.87±5.48 % vs. 21.19±8.27 %; p=0.079), and LV EF (62.67±6.61 % vs. 58.77±10.51 %; p=0.191). Compared to patients free of cardiac complications, patients with cardiac complications exhibited a significantly reduced LV GLS (-12.64±3.39 % vs. 14.69±2.05; p=0.006) (Figure 1).
Analysis of the receiver operating characteristics (ROC) curve (Figure 2) showed an area under the curve of 0.68 (95%CI=0.62-0.73) with a best GLS cut-off of -11.85 % for the detection of cardiac complications (p=0.012). This cut-off had a sensitivity of 50.0% (95%CI=28.2-71.8%) and a specificity of 91.8% (95%CI=87.6-94.9%).
The ROC curve did not reveal a global heart T2* threshold [AUC=0.58 (95%CI=0.51-0.64); p=0.187] or a LV EF threshold [AUC=0.58 (95%CI=0.52-0.64); p=0.258] below which the probability of detecting the presence of cardiac complications increases significantly with satisfying sensitivity and specificity.
Conclusion:
In our population of well-treated TM patients, not heavily iron loaded at the cardiac level, GLS emerged as a more sensitive marker of cardiac complications compared to cardiac T2* values. Our findings emphasize the importance of evaluating LV GLS in the routine CMR assessment of β-TM patients.
