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Myocardial iron overload assessment by T2* magnetic resonance imaging in adult transfusion dependent patients with acquired anemias

¹ Ematologia e Centro Trapianti, Centro Oncologico di Riferimento regionale "Armando Businco", Cagliari
² Radiologia Ospedale "Brotzu", Cagliari
³ Ematologia Ospedale di Nuoro
⁴ Centro Trapianti, Ospedale Binaghi, Cagliari
⁵ Ospedale Microcitemico, Cagliari, Italy

Correspondence: Emanuele Angelucci, MD, U.O. Ematologia, Ospedale Oncologico "A. Businco", via Edward Jenner, 09121 Cagliari, Italy. E-mail:emnang{at}tin.it

Only limited data are available regarding myocardial iron overload in adult patients with transfusion dependent acquired anemias. To address this topic using MRI T2* we studied 27 consecutive chronic transfusion dependent patients with acquired anemias: (22 myelodysplastic syndrome, 5 primary myelofibrosis). Cardiac MRI T2* values obtained ranged from 5.6 to 58.7 (median value 39.8) milliseconds. Of the 24 analyzable patients, cardiac T2* correlated with transfusion burden (p=0.0002). No patient who had received less than 290 mL/kg of packed red blood cells (101 units=20 grams of iron) had a pathological cardiac T2* value (< 20 ms). All patients who had received at least 24 PRBC units showed MRI T2* detectable hepatic iron (liver T2* value 6.3 ms). Only patients with severe hepatic iron overload (T2* <1.4 ms) showed cardiac T2* value indicative of dangerous myocardial iron deposition. Serum ferritin was not significantly correlated with cardiac T2* (p=0.24). Gradient echo T2* magnetic resonance imaging provides a rapid and reproducible method for detecting myocardial iron overload which developed after a heavy transfusion burden equal to or greater than 290 mL/kg of packed red blood cell units.

Key words: cardiac iron, myelodysplastic syndromes, magnetic resonance imaging, T2*.