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Left ventricular global function index and left ventricular mass volume ratio by CMR: relation with heart failure in Thalassemia major patients

  • Antonella Meloni
  • Petra Keilberg
  • Stefania Renne
  • Gianluca Valeri
  • Elisabetta Chiodi
  • Vincenzo Positano
  • Roberto Sarli
  • Carla Cirotto
  • Mari Giovanna Neri
  • Alessia Pepe
Open Access
Poster presentation
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Keywords

Heart Failure Cardiovascular Magnetic Resonance Left Ventricular Mass Thalassemia Thalassemia Major 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Background

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.

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.

Funding

The MIOT project receives "no-profit support" from industrial sponsorships (Chiesi Farmaceutici S.p.A. and ApoPharma Inc.).

Copyright information

© Meloni et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors and Affiliations

  • Antonella Meloni
    • 1
  • Petra Keilberg
    • 1
  • Stefania Renne
    • 2
  • Gianluca Valeri
    • 3
  • Elisabetta Chiodi
    • 4
  • Vincenzo Positano
    • 1
  • Roberto Sarli
    • 5
  • Carla Cirotto
    • 6
  • Mari Giovanna Neri
    • 1
  • Alessia Pepe
    • 1
  1. 1.CMR UnitFondazione G. Monasterio CNR-Regione ToscanaPisaItaly
  2. 2.Struttura Complessa di Cardioradiologia-UTICP.O. "Giovanni Paolo II"Lamezia TermeItaly
  3. 3.Dipartimento di RadiologiaAzienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-Lancisi-Salesi"AnconaItaly
  4. 4.Servizio RadiologiaOspedaliera-Universitaria Arcispedale "S. Anna"FerraraItaly
  5. 5.Centro MicrocitemiaASL Taranto Presidio Ospedaliero Orientale "M. Giannuzzi"ManduriaItaly
  6. 6.Servizio trasfusionaleAzienda USL n° 1SassariItaly

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