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Left ventricular global function index and left lentricular mass volume ratio by CMR: association with heart failure in thalassemia major patients

Session Best Posters session 3

Speaker Antonella Meloni

Event : ESC Congress 2015

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance (CMR)
  • Session type : Best ePosters

Authors : A Meloni (Pisa,IT), V Positano (Pisa,IT), C Tudisca (Palermo,IT), E Chiodi (Ferrara,IT), A Vallone (Catania,IT), MG Neri (Pisa,IT), G Palazzi (Modena,IT), D Maddaloni (Fabriano (AN),IT), P Keilberg (Pisa,IT), A Pepe (Pisa,IT)

Authors:
A. Meloni1 , V. Positano1 , C. Tudisca2 , E. Chiodi3 , A. Vallone4 , M.G. Neri1 , G. Palazzi5 , D. Maddaloni6 , P. Keilberg1 , A. Pepe1 , 1Fondazione G. Monasterio CNR-Regione Toscana, CMR Unit - Pisa - Italy , 2Policlinico “Paolo Giaccone”, Istituto di Radiologia - Palermo - Italy , 3Arcispedale Sant'Anna, Servizio Radiologia Ospedaliera-Universitaria - Ferrara - Italy , 4Az. Osp. “Garibaldi” Presidio Ospedaliero Nesima, Istituto di Radiologia - Catania - Italy , 5Policlinico di Modena, Oncoematologia Pediatrica - Modena - Italy , 6Osp. “Engles Profili”, Dip. Materno/Infantile - Fabriano (AN) - Italy ,

Topic(s):
Cardiovascular Magnetic Resonance (CMR)

Citation:
European Heart Journal ( 2015 ) 36 ( Abstract Supplement ), 379

Introduction: Recently two novels indicators of left ventricular (LV) performance assessed by Cardiovascular Magnetic Resonance (CMR) have been introduced: the LV global function index (LVGFI) and the LV mass/volume ratio (LVMVR). The LVGFI combines LV stroke volume, end-systolic and end diastolic volumes, as well as LV mass, integrating structural as well as mechanical behaviour. Elevated LVMVR is indicative of concentric remodelling. A LVGFI <37% and a LVMVR>1 were shown to be associated with the occurrence of cardiovascular events in no-thalassemic populations.

Purpose: This retrospective cohort study aimed to systematically evaluate in a large historical cohort of thalassemia major (TM) in the CMR era whether the LVGFI and the LVMVR were associated with a higher risk of heart failure.

Methods: We considered 812 TM patients (391 M, 30.4±8.6 years), consecutively enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. LVGFI and LVMRI were quantitatively evaluated by SSFP cine images. The T2* value in all the 16 cardiac segments was evaluated and a global heart T2* value <20 ms was considered indicative of myocardial iron overload (MIO).

Results: Eighty (9.9%) patients had a LVGFI<37% and, compared to the patients with a normal LVGFI, they showed a significant higher frequency of heart failure (43.8% vs 4.2%; P<0.0001). Patients with a LVGFI<37% had a significant higher risk of heart failure (odds-ratio-OR=17.59, 95% CI: 9.95–21.09; P=<0.001). The risk remained significant also adjusting for the presence of MIO (OR=15.54, 95% CI: 8.05–26.27; P=<0.001).

Thirty (3.7%) patients had a LVMVR≥1% and, compared to the patients with a normal LVMRI, they showed a significant higher frequency of heart failure (20.0% vs 7.7%; P=0.015). Patients with a LVMVR≥1% had a significant higher risk of heart failure (OR=3.01, 95% CI: 1.18–7.64; P=0.021). The risk remained significant also adjusting for the presence of MIO (OR=3.44, 95% CI: 1.31–9.01; P=0.012).

In a multivariate model including LVGFI, LVMVR and heart iron, the significant predictors of heart failure were a LVGFI<37% (OR=14.05, 95% CI: 7.66–25.77; P=<0.001) and a global heart T2*<20 ms (OR=1.94, 95% CI: 1.08–3.47; P=0.026).

Conclusions: In TM patients a LVGFI<37% was associated with an higher risk of heart failure, independent by the presence of MIO. A widespread program using CMR exploiting its multi-parametric potential can have considerable power for the early identification and treatment of patients at risk for heart failure.

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