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Left atrial size and function assessment through CMR in thalassemia major patients

Session Poster session 2

Speaker Camilla Torlasco

Event : EuroCMR 2019

  • Topic : imaging
  • Sub-topic : Cardiac Magnetic Resonance: Systolic and Diastolic Function
  • Session type : Poster Session

Authors : C Torlasco (Milan,IT), C Mollica (Milan,IT), E Cassinerio (Milan,IT), E Ruffino (Milan,IT), A Milazzo (Milan,IT), G Quattrocchi (Milan,IT), P Sormani (Milan,IT), A Abdel-Gadir (London,GB), C Giannattasio (Milan,IT), G Parati (Milan,IT), MD Cappellini (Milan,IT), JC Moon (London,GB), P Pedrotti (Milan,IT)

Authors:
C Torlasco1 , C Mollica1 , E Cassinerio2 , E Ruffino1 , A Milazzo3 , G Quattrocchi3 , P Sormani3 , A Abdel-Gadir4 , C Giannattasio3 , G Parati1 , MD Cappellini2 , JC Moon4 , P Pedrotti3 , 1IRCCS Istituto Auxologico Italiano - Milan - Italy , 2IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico - Milan - Italy , 3Niguarda Ca' Granda Hospital - Milan - Italy , 4Barts Health NHS Trust - London - United Kingdom of Great Britain & Northern Ireland ,

Citation:
European Heart Journal - Cardiovascular Imaging ( 2019 ) 20 ( Supplement 2 ), ii339

Background. Heart disease is still Thalassemia Major (TM) patients' leading cause of death. Growing evidences point out atrial function and global longitudinal strain (GLS) as early hallmarks of iron cardiomyopathy. Purpose. To investigate left atrial size and function and GLS in TM patients, in order to detect early myocardial iron overload (MIO) induced heart damage. Methods. 1.5T CMR classified 81 white TM patients in "MIO+" (T2*<20ms) and "MIO-" (T2*>20ms). Biplane measurement method at 3 time points (maximum, minimum and pre-atrial contraction) were used to calculate atrial functions (reservoir, conduit and emptying function); LV GLS from 2- and 4-chambers cines was also calculated. Results. See Table1. Age (35.5±8 vs 37.7±8y) and Hb (9.6±0.6 vs 9.9±0.9g/L) were balanced; body surface area was greater in MIO+ (1.5±0.2 vs 1.6±0.2, p=0.02). No differences observed in LV size, EF, GLS, but LV EF tended to be higher in MIO- (0.63±0.5 vs 0.66±0.5, p=0.06). LA indexed total emptying volume was similar between groups (29.6±13 vs 28.7±14ml/m2), however, MIO+ patients had less passive atrial emptying and more active contraction emptying (p=0.01). Conclusions. 1) In MIO+ patients with preserved LV size and systolic function, the contribution of atrial contraction to total atrial emptying is higher than in TM MIO- patients, as observed in restrictive LV filling pattern. We hypothesise that iron deposition in the atria may be contributing to these pathophysiological changes. 2)The % of atrial emptying due to atrial contraction observed in TM MIO- patients is higher than the published reference values in general population, suggesting that a different threshold for atrial function should be used, as for LVEF, in TM patients, accounting for hyperdynamic circulation in residual anaemia.

MIO + (N=20 MIO-(N=61) T-test
mean ±SD mean ±SD p
T2* (ms) 13.5 ±5.6 34.7 ±10.6 <0.001
LAsize Minimum volume i (ml/m2) 23.4 ±12 27.1 ±11 0.139
Pre-atrial contraction volume i (ml/m2) 33.8 ±15 34.6 ±14 0.418
Maximum volume i (ml/m2) 53 ±20 55.9 ±21 0.27
LA conduit EF 0.56 ±0.1 0.53 ±0.2 0.08
% of passive emptying 63.5 ±22 73.4 ±19 0.01
LA pump % of active emptying 36.5 ±22 16.6 ±18 0.01
LV GLS -20.9 ±2.1 -21.21 ±2.1 0.302

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