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Movement abnormalities in the left ventricle of thalassemia major patients
Authors : A Meloni (Pisa,IT), L Gulino (Pisa,IT), C Argento (Agrigento,IT), MC Galati (Catanzaro,IT), V Positano (Pisa,IT), P Keilberg (Pisa,IT), C Tudisca (Palermo,IT), M Missere (Campobasso,IT), M Lombardi (Pisa,IT), A Pepe (Pisa,IT)
A. Meloni1
,
L. Gulino1
,
C. Argento2
,
M.C. Galati3
,
V. Positano1
,
P. Keilberg1
,
C. Tudisca4
,
M. Missere5
,
M. Lombardi1
,
A. Pepe1
,
1CMR Unit, Fondazione G.Monasterio CNR-Regione Toscana and Institute of Clinical Physiology - Pisa - Italy
,
2Centro di Talasssemia Ospedale San Giovanni Di Dio - Agrigento - Italy
,
3UO Ematoncologia Pediatrica - UOS Talassemie A.O. "Pugliese-Ciaccio" - Catanzaro - Italy
,
4Istituto di Radiologia Policlinico Paolo Giaccone - Palermo - Italy
,
5Catholic University of the Sacred Heart, Department of Radiology - Campobasso - Italy
,
Purpose: Movement abnormalities of the left ventricle (LV) have been reported in thalassemia major patients. We investigated the relationships between movement abnormalities and myocardial iron overload (MIO) and fibrosis, detected by cardiovascular magnetic resonance (CMR).
Methods: 1092 patients (537 male; 30.6±8.5 years) were considered. Cine images were acquired in short, vertical and horizontal long-axis plans. MIO was measured by multislice multi-echo T2* technique. To detect myocardial fibrosis, late gadolinium enhanced (LGE) images were acquired. For image analysis the 17-segment LV model of the AHA/ACC was taken into account. Segmental wall motion was visually assessed and scored as 1=normal, 2=hypokinesia, 3=akinesia and 4=dyskinesia. The T2* value in all segments as well as the global value were calculated. Presence of LGE was assessed for each segment.
Results: Abnormal LV motion was found in 66 (6%) patients (60 hypokinetic and 6 dyskinetic) with a predominant involvement of medium anterior, anterolateral and septal segments.
Patients with abnormal motion had significantly lower global T2* value (22.5±14.7 ms versus 28.9±11.9 ms; P=0.001) and significantly higher number of segments with T2*<20 ms (8.6±7.5 versus 4.6±6.1; P<0.0001).
LGE areas were detected in 196 patients (18%) and were predominantly located in the mid-ventricular septum. There was a significant correlation between LGE and abnormal motion: 34 (17.4%) patients with LGE had abnormal motion while among the 896 patients without LGE 32 (3.6%) had abnormal motion (P<0.0001).
Conclusions: Movement abnormalities in the left ventricle were not really frequent in thalassemia major patients but were associated with MIO and myocardial fibrosis.
ESC Professional Members, Association Members (Ivory & above) benefit from year-round access to all the resources from their respective Association, and to all content from previous years. Fellows of the ESC (FESC), and professionals in training or under 40 years old, who subscribed to a Young Combined Membership package benefit from access to all ESC 365 content from all events, all editions, all year long. Find out more about ESC Memberships here.
