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Heart disease and pancreatic iron in thalassemia major

Session Poster Session 1

Speaker Antonella Meloni

Event : ESC Congress 2019

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

Authors : A Meloni (Pisa,IT), L Pistoia (Pisa,IT), G Restaino (Campobasso,IT), S Renne (Lamezia Terme,IT), N Giunta (Palermo,IT), R Righi (Lagosanto (FE),IT), P Giuliano (Palermo,IT), A Riva (Taranto,IT), P Giovangrossi (Latina,IT), A Vitucci (Bari,IT), V Positano (Pisa,IT), A Pepe (Pisa,IT)

Authors:
A. Meloni1 , L. Pistoia1 , G. Restaino2 , S. Renne3 , N. Giunta4 , R. Righi5 , P. Giuliano4 , A. Riva6 , P. Giovangrossi7 , A. Vitucci8 , V. Positano1 , A. Pepe1 , 1Fondazione Toscana Gabriele Monasterio - Pisa - Italy , 2Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche - “Giovanni Paolo II” - Campobasso - Italy , 3Presidio Ospedaliero “Giovanni Paolo II” - Lamezia Terme - Italy , 4Ospedale Civico - Palermo - Italy , 5Ospedale del Delta - Lagosanto (FE) - Italy , 6OSP. SS. Annunziata ASL Taranto - Taranto - Italy , 7Ospedale S. M. Goretti - Latina - Italy , 8Polyclinic Hospital of Bari - Bari - Italy ,

Topic(s):
Cardiac Magnetic Resonance

Citation:
European Heart Journal ( 2019 ) 40 ( Supplement ), 212

Background: Some preliminary data have postulated a correlation between pancreatic iron overload and heart iron and function in thalassemia major (TM) patients.

Purpose: In the present multicenter study we explored systematically the link between pancreatic iron and heart disease in a large cohort of TM patients.

Methods: We considered 880 TM patients (467 M, mean age 37.83±10.05 years) enrolled in the E-MIOT (Extension-Myocardial Iron Overload in Thalassemia) project. T2* measurements were performed over pancreatic head, body and tail and global value was the mean. Myocardial iron overload (MIO) was quantified using a T2* segmental approach. Biventricular function parameters were assessed by cine images. Late gadolinium enhancement (LGE) images were acquired to detect myocardial fibrosis.

Results: A significant correlation between pancreatic and cardiac iron was reconfirmed in this more numerous population and a normal pancreas T2* showed negative predictive value of 100% for cardiac iron.

LGE sequences were acquired in 273 TM patients and 84 (30.77%) of them showed macroscopic myocardial fibrosis. Global pancreas T2* values were significantly lower in patients with fibrosis (7.38±6.19 ms vs 11.91±9.79 ms; P<0.0001).

Sixty-four patients had at least one cardiac complication (arrhythmias, heart failure, pulmonary hyperthension, vascular disease). Patients with cardiac complications showed a significant lower global pancreas T2* (7.83±5.61 ms vs 12.76±10.34 ms; P=0.024). Specifically, global pancreas T2* values were significantly lower in patients with heart failure as well as in patients with arrhythmias and all patients with one of these two diseases had a pathologic global pancreas T2* value (see Figure).

Conclusion: Pancreatic iron is a strong predictor not only for cardiac iron, but also for cardiac complications supporting a more profound link between pancreatic iron and heart disease in TM.

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