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Myocardial native T1 mapping and cardiac outcomes in thalassemia major

Session ePoster session

Speaker Antonella Meloni

Event : EACVI Best of Imaging 2020

  • Topic : imaging
  • Sub-topic : T1 and T2 Mapping
  • Session type : ePosters

Authors : A Meloni (Pisa,IT), N Martini (Pisa,IT), A De Luca (Trieste,IT), V Positano (Pisa,IT), L Pistoia (Pisa,IT), C Gerardi (Sciacca,IT), PMG Sanna (Sassari,IT), PP Bitti (Nuoro,IT), M Benni (Bologna,IT), F Sorrentino (Rome,IT), G Sinagra (Trieste,IT), A Pepe (Pisa,IT)

Authors:
A Meloni1 , N Martini1 , A De Luca2 , V Positano1 , L Pistoia1 , C Gerardi3 , PMG Sanna4 , PP Bitti5 , M Benni6 , F Sorrentino7 , G Sinagra2 , A Pepe1 , 1Fondazione Toscana Gabriele Monasterio - Pisa - Italy , 2University of Trieste - Trieste - Italy , 3GIOVANNI PAOLO II Hospital - Sciacca - Italy , 4University of Sassari - Sassari - Italy , 5San Francesco Hospital - Nuoro - Italy , 6Azienda Ospedaliero, Universitaria di Bologna, Policlinico S.Orsola-Malpigh - Bologna - Italy , 7S. Eugenio Hospital - Rome - Italy ,

Topic(s):
T1 and T2 Mapping, T2*

Background. The T2* cardiovascular magnetic resonance (CMR) is the gold standard for the non invasive detection of myocardial iron overload (MIO). The native myocardial T1 mapping has been proposed as a complementary tool, thanks to its higher sensitivity in presence of small amounts of iron, but no data are available in literature about its clinical impact.

Objective: To explore the clinical impact of T1 mapping for detecting cardiac complications in thalassemia major (TM).

Methods. We considered 146 TM patients (87 females, 38.7±11.1 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Three parallel short-axis slices of the left ventricle (LV) were acquired with the Modified Look-Locker Inversion recovery (MOLLI) sequence. The native T1 values in all 16 myocardial segments were obtained and the global value was the mean.

Results. Twenty-one patients had an history of cardiac complications: 11 heart failure,  8 arrhythmias (7 supraventricular and 1 ventricular), and 2 pulmonary hyperthension.

Patients with cardiac complications had significantly lower global heart T1 values (879.3±121.9 ms vs 963.2±98.5 ms; P<0.0001) (Figure) but comparable T2* values (33.32±11.66 ms vs 37.17±9.15 ms; P=0.116). Cardiac complications were more frequent in the group of patients with reduced global heart T1 value (<928 ms for males and <989 ms for females) compared to the group with normal global heart T1 value (71.4% vs 39.5%; P=0.009). Odds ratio (OR) for cardiac complications was 3.8 (95%CI=1.3-10.9) for patients with reduced global heart T1 value versus patients with normal global heart T1 value.

Conclusion: We found out a significant association between decreased native global heart T1 values and a history of cardiac complications, suggesting that an early detection of myocardial iron  burden by  native T1 can support the clinicians in modifing chelation therapy earlier.

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