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The role of left ventricular global function index for the prediction of cardiac complications in thalassemia major.

Session Poster session 4

Speaker Antonella Meloni

Event : ESC Congress 2014

  • Topic : heart failure
  • Sub-topic : Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : A Meloni (Pisa,IT), G Rossi (Pisa,IT), B Pagano (Locri,IT), E Facchini (Bologna,IT), P Keilberg (Pisa,IT), S Renne (Lamezia Terme,IT), M Missere (Campobasso,IT), E Chiodi (Ferrara,IT), V Positano (Pisa,IT), A Pepe (Pisa,IT)

Authors:
A. Meloni1 , G. Rossi2 , B. Pagano3 , E. Facchini4 , P. Keilberg1 , S. Renne5 , M. Missere6 , E. Chiodi7 , V. Positano1 , A. Pepe1 , 1Fondazione G. Monasterio CNR-Regione Toscana, CMR Unit - Pisa - Italy , 2Institute of Clinical Physiology, CNR, Epidemiology and Biostatistics Unit - Pisa - Italy , 3Presidio Ospedaliero Locri - A.S.L. n. 9, Centro Microcitemico. U.O. di Pediatria e Neonatologia - Locri - Italy , 4Policlinico Universitario S. Orsola-Malpighi, U.O. Pediatria - Pession, M.O. Oncologia ed Ematologia Pediatrica “Lalla Seràgnoli” - Bologna - Italy , 5P.O. “Giovanni Paolo II”, Struttura Complessa di Radiologia - Lamezia Terme - Italy , 6Università Cattolica del Sacro Cuore, Dipartimento di Radiologia - Campobasso - Italy , 7Arcispedale “S. Anna”, Servizio Radiologia Ospedaliera-Universitaria - Ferrara - Italy ,

Topic(s):
Prognosis

Citation:
European Heart Journal ( 2014 ) 35 ( Abstract Supplement ), 673

Purpose: Cardiac complications are one of the main causes of death in thalassemia major (TM) patients. Recently, the MESA study showed the strong predictive value of the left ventricular global function index (LVGFI) evaluated by cardiovascular magnetic resonance (CMR) in the prediction of the of cardiovascular events. LVGFI is a functional parameter integrating structural as well as mechanical behaviour derived from the analysis of cine SSFP images.

We evaluated the predictive value of LVGFI and other CMR parameters for cardiac complications in thalassemia major (TM).

Methods: We followed prospectively 537 white TM patients enrolled in the MIOT network. Fifty patients were excluded from the analysis because a cardiac complication was present at the time of the first CMR. All prognostic variables associated with the outcome at the univariate Cox model were placed in the multivariate model and were ruled out if they did not significantly improve the adjustment.

Results: At baseline the mean age was 29.5±9.0 years and 222 patients were males. The mean follow-up time was 58±18 months. After the first CMR only the 37.8% of the patients did not change the chelation regimen or the frequency/dosage. We recorded 40 cardiac complications: 19 episodes of HF, 19 arrhythmias, all supraventicular hyperhyperkinetic, and 2 pulmonary hypertensions.

A LVGFI<37% was a significant univariate prognosticator of cardiac complications (HR=3.42, 95%CI=1.56-7.52, P=0.002). The other significant univariate prognosticators were myocardial iron overload (MIO), atrial dilatation, ventricular dysfunction evaluated by the left ventricular ejection fraction (LVEF), and myocardial fibrosis. Serum ferritin and liver iron by T2* MR were not predictive factors for cardiac complications.

In the multivariate analysis the independent predictive factors were a LVGFI<37% (HR=3.08, 95%CI=1.32-7.20, P=0.010), an homogeneous pattern of MIO (compared to no MIO) (HR=3.95, 95%CI=1.56-10.04, P=0.001), and myocardial fibrosis (HR=3.45, 95%CI=1.68-7.09, P=0.001).

Conclusions: We detected few cardiac events thanks to a CMR-guided, patient-specific adjustment of the chelation therapy. A LVGFI<37%, severe and homogeneous MIO, and myocardial fibrosis identify patients at high risk of cardiac complications globally considered. Importantly, the dysfunction evaluated by the LVEF lose its predictive value for cardiac complications when included in a multivariate model.

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