Myocardial deformation in iron overload cardiomyopathy: speckle tracking imaging in a beta-thalassemia major population

Luca Antonio Felice Di Odoardo, Marianna Giuditta, Elena Cassinerio, Alberto Roghi, Patrizia Pedrotti, Marco Vicenzi, Veronica Maria Sciumbata, Maria Domenica Cappellini, Alberto Pierini

Research output: Contribution to journalArticle

Abstract

Traditional echocardiography is unable to detect neither the early stages of iron overload cardiomyopathy nor myocardial iron deposition. The aim of the study is to determine myocardial systolic strain indices in thalassemia major (TM), and assess their relationship with T2*, a cardiac magnetic resonance index of the severity of cardiac iron overload. 55 TM cases with recent cardiac magnetic resonance (CMR-T2*) underwent speckle tracking analysis to assess regional myocardial strains and rotation. The results were compared with a normal control group (n = 20), and were subsequently analyzed on the basis of the CMR-T2* values. Two TM groups were studied: TM with significant cardiac iron overload (“low” T2*, ≤20 ms; n = 21), and TM with normal T2* values (“normal” T2*, >20 ms; n = 34). TM patients show significant, uniform decrease in circumferential and radial strain (P < 0.05), and a remarkable reduction in end-systolic rotation, both global, and for all segments (P < 0.001). No significant differences were found between the low- and the normal T2* group either in regional strains and rotation or in standard echocardiographic and CMR parameters. Spearman’s correlation coefficient shows no significant correlation between myocardial strains, rotation and cardiac T2* values. In conclusion, our results are in accordance with recent evidence that myocardial iron overload is not the only mechanism underlying iron cardiomyopathy in TM. Strain imaging can predict subclinical myocardial dysfunction irrespective of CMR-T2* values, although it cannot replace CMR-T2* in assessing cardiac iron overload. Finally, it might be useful to appropriately time cardioactive treatment.

Original languageEnglish
Pages (from-to)799-809
Number of pages11
JournalInternal and Emergency Medicine
Volume12
Issue number6
DOIs
Publication statusPublished - Sep 1 2017

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Iron Overload
beta-Thalassemia
Cardiomyopathies
Population
Magnetic Resonance Spectroscopy
Iron
Echocardiography
Reference Values
Control Groups

Keywords

  • Beta-thalassemia major
  • Cardiac magnetic resonance T2*
  • Iron overload cardiomyopathy
  • Strain imaging

ASJC Scopus subject areas

  • Internal Medicine
  • Emergency Medicine

Cite this

Myocardial deformation in iron overload cardiomyopathy : speckle tracking imaging in a beta-thalassemia major population. / Di Odoardo, Luca Antonio Felice; Giuditta, Marianna; Cassinerio, Elena; Roghi, Alberto; Pedrotti, Patrizia; Vicenzi, Marco; Sciumbata, Veronica Maria; Cappellini, Maria Domenica; Pierini, Alberto.

In: Internal and Emergency Medicine, Vol. 12, No. 6, 01.09.2017, p. 799-809.

Research output: Contribution to journalArticle

Di Odoardo, Luca Antonio Felice ; Giuditta, Marianna ; Cassinerio, Elena ; Roghi, Alberto ; Pedrotti, Patrizia ; Vicenzi, Marco ; Sciumbata, Veronica Maria ; Cappellini, Maria Domenica ; Pierini, Alberto. / Myocardial deformation in iron overload cardiomyopathy : speckle tracking imaging in a beta-thalassemia major population. In: Internal and Emergency Medicine. 2017 ; Vol. 12, No. 6. pp. 799-809.
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AB - Traditional echocardiography is unable to detect neither the early stages of iron overload cardiomyopathy nor myocardial iron deposition. The aim of the study is to determine myocardial systolic strain indices in thalassemia major (TM), and assess their relationship with T2*, a cardiac magnetic resonance index of the severity of cardiac iron overload. 55 TM cases with recent cardiac magnetic resonance (CMR-T2*) underwent speckle tracking analysis to assess regional myocardial strains and rotation. The results were compared with a normal control group (n = 20), and were subsequently analyzed on the basis of the CMR-T2* values. Two TM groups were studied: TM with significant cardiac iron overload (“low” T2*, ≤20 ms; n = 21), and TM with normal T2* values (“normal” T2*, >20 ms; n = 34). TM patients show significant, uniform decrease in circumferential and radial strain (P < 0.05), and a remarkable reduction in end-systolic rotation, both global, and for all segments (P < 0.001). No significant differences were found between the low- and the normal T2* group either in regional strains and rotation or in standard echocardiographic and CMR parameters. Spearman’s correlation coefficient shows no significant correlation between myocardial strains, rotation and cardiac T2* values. In conclusion, our results are in accordance with recent evidence that myocardial iron overload is not the only mechanism underlying iron cardiomyopathy in TM. Strain imaging can predict subclinical myocardial dysfunction irrespective of CMR-T2* values, although it cannot replace CMR-T2* in assessing cardiac iron overload. Finally, it might be useful to appropriately time cardioactive treatment.

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