Iron Overload in Polytransfused Patients without Heart Failure is Associated with Subclinical Alterations of Systolic Left Ventricular Function using Cardiovascular Magnetic Resonance Tagging.
Summary of "Iron Overload in Polytransfused Patients without Heart Failure is Associated with Subclinical Alterations of Systolic Left Ventricular Function using Cardiovascular Magnetic Resonance Tagging."
ABSTRACT:
BACKGROUND:
It remains incompletely understood whether patients with transfusion related cardiac iron overload without signs of heart failure exhibit already subclinical alterations of systolic left ventricular (LV) dysfunction. Therefore we performed a comprehensive evaluation of systolic and diastolic cardiac function in such patients using tagged and phase-contrast CMR.
METHODS:
19 patients requiring regular blood transfusions for chronic anemia and 8 healthy volunteers were investigated using cine, tagged, and phase-contrast and T2* CMR. LV ejection fraction, peak filling rate, end-systolic global midventricular systolic Eulerian radial thickening and shortening strains as well as left ventricular rotation and twist, mitral E and A wave velocity, and tissue e' wave and E/e' wave velocity ratio, as well as isovolumic relaxation time and E wave deceleration time were computed and compared to cardiac T2*.
RESULTS:
Patients without significant iron overload (T2*>20 ms, n=9) had similar parameters of systolic and diastolic function as normal controls, whereas patients with severe iron overload (T2*<10 ms, n=5), had significant reduction of LV ejection fraction (54+/-2% vs. 62+/-6% and 65+/-6% respectively p<0.05), of end-systolic radial thickening (+6+/-4% vs. +11+/-2 and +11+/-4% respectively p<0.05) and of rotational twist (1.6+/-0.2 degrees vs. 3.0+/-1.2 and 3.5+/-0.7 degrees respectively, p<0.05) than patients without iron overload (T2*>20 ms) or normal controls. Patients with moderate iron overload (T2* 10-20 ms, n=5), had preserved ejection fraction (59+/-6%, p=NS vs. pts. with T2*>20 ms and controls), but showed reduced maximal LV rotational twist (1.8+/-0.4 degrees). The magnitude of reduction of LV twist (r=0.64, p<0.001), of LV ejection fraction (r=0.44, p<0.001), of peak radial thickening (r=0.58, p<0.001) and of systolic (r=0.50, p<0.05) and diastolic twist and untwist rate (r=-0.53, p<0.001) in patients were directly correlated to the logarithm of cardiac T2*.
CONCLUSION:
Multiple transfused patients with normal ejection fraction and without heart failure have subclinical alterations of systolic and diastolic LV function in direct relation to the severity of cardiac iron overload. Among all parameters, left ventricular twist is affected earliest, and has the highest correlation to log (T2*), suggesting that this parameter might be used to follow systolic left ventricular function in patients with iron overload.
Affiliation
Journal Details
This article was published in the following journal.
Name: Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance
ISSN: 1532-429X
Pages: 23
Links
- PubMed Source: http://www.ncbi.nlm.nih.gov/pubmed/21518461
- DOI: http://dx.doi.org/10.1186/1532-429X-13-23
Medical and Biotech [MESH] Definitions
Heart Failure
A heterogeneous condition in which the heart is unable to pump out sufficient blood to meet the metabolic need of the body. Heart failure can be caused by structural defects, functional abnormalities (VENTRICULAR DYSFUNCTION), or a sudden overload beyond its capacity. Chronic heart failure is more common than acute heart failure which results from sudden insult to cardiac function, such as MYOCARDIAL INFARCTION.
Cardiomegaly
Enlargement of the HEART, usually indicated by a cardiothoracic ratio above 0.50. Heart enlargement may involve the right, the left, or both HEART VENTRICLES or HEART ATRIA. Cardiomegaly is a nonspecific symptom seen in patients with chronic systolic heart failure (HEART FAILURE) or several forms of CARDIOMYOPATHIES.
Iron Overload
An excessive accumulation of iron in the body due to a greater than normal absorption of iron from the gastrointestinal tract or from parenteral injection. This may arise from idiopathic hemochromatosis, excessive iron intake, chronic alcoholism, certain types of refractory anemia, or transfusional hemosiderosis. (From Churchill's Illustrated Medical Dictionary, 1989)
Xamoterol
A selective beta-1-adrenergic partial agonist. Because it is a partial agonist (DRUG PARTIAL AGONISM) it acts like an agonist when sympathetic activity is low and as an antagonist when sympathetic activity is high. It reduces MYOCARDIAL ISCHEMIA and improves ventricular function in patients with mild to moderate heart failure. In patients with severe heart failure it has been shown to produce benefits in systolic and diastolic function.
Heart Failure, Systolic
Heart failure caused by abnormal myocardial contraction during SYSTOLE leading to defective cardiac emptying.
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