Abstract
Heart failure due to myocardial iron overload remains the leading cause of death in patients with transfusion‐dependent anemias. Iron overload‐induced cardiomyopathy is reversible if intensive chelation therapy is instituted on time. Thus, early detection of myocardial iron deposition is imperative to prevent overt heart failure. Conventional cardiac monitoring, including physical examination, electrocardiography, echocardiography or serum ferritin levels fail to predict manifest or subclinical myocardial involvement resulting from iron overload. Cardiovascular magnetic resonance imaging T2* (cMRI‐T2*, pronounced T2 star) times correlate well with myocardial iron levels. This timely review focuses on the utility of cMRI‐T2*, for the preclinical detection of myocardial iron overload and monitoring of myocardial iron content during chelation therapy. Copyright © 2008 Wiley Periodicals, Inc.
Keywords: cardiac magnetic resonance imaging T2*, siderosis, hemochromatosis, myocardial iron overload, ferritin, heart failure
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REFERENCES
- 1. Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, et al.: Cardiovascular T2‐star (T2*) magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J 2001; 22: 2171–2179. [DOI] [PubMed] [Google Scholar]
- 2. Aldouri MA, Wonke B, Hoffbrand AV, Flynn DM, Ward SE, et al.: High incidence of cardiomyopathy in beta‐thalassaemia patients receiving regular transfusion and iron chelation: reversal by intensified chelation. Acta Haematol 1990; 84: 113–117. [DOI] [PubMed] [Google Scholar]
- 3. Davis BA, Porter JB: Long‐term outcome of continuous 24‐hour deferoxamine infusion via indwelling intravenous catheters in high‐risk beta‐thalassemia. Blood 2000; 95: 1229–1236. [PubMed] [Google Scholar]
- 4. Nienhuis AW, Griffith P, Strawczynski H, Henry W, Borer J, et al.: Evaluation of cardiac function in patients with thalassemia major. Ann N Y Acad Sci 1980; 344: 384–396. [DOI] [PubMed] [Google Scholar]
- 5. Buja LM, Roberts WC: Iron in the heart. Etiology and clinical significance. Am J Med 1971; 51: 209–221. [DOI] [PubMed] [Google Scholar]
- 6. Anderson LJ, Westwood MA, Holden S, Davis B, Prescott E, et al.: Myocardial iron clearance during reversal of siderotic cardiomyopathy with intravenous desferrioxamine: a prospective study using T2* cardiovascular magnetic resonance. Br J Haematol 2004; 127: 348–355. [DOI] [PubMed] [Google Scholar]
- 7. Westwood MA, Anderson LJ, Firmin DN, Gatehouse PD, Lorenz CH, et al.: Interscanner reproducibility of cardiovascular magnetic resonance T2* measurements of tissue iron in thalassemia. J Magn Reson Imaging 2003; 18: 616–620. [DOI] [PubMed] [Google Scholar]
- 8. Ghugre NR, Enriquez CM, Coates TD, Nelson MD Jr, Wood JC: Improved R2* measurements in myocardial iron overload. J Magn Reson Imaging 2006; 23: 9–16. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9. Pepe A, Positano V, Santarelli MF, Sorrentino F, Cracolici E, et al.: Multislice multiecho T2* cardiovascular magnetic resonance for detection of the heterogeneous distribution of myocardial iron overload. J Magn Reson Imaging 2006; 23: 662–668. [DOI] [PubMed] [Google Scholar]
- 10. Wood JC, Tyszka JM, Carson S, Nelson MD, Coates TD: Myocardial iron loading in transfusion‐dependent thalassemia and sickle cell disease. Blood 2004; 103: 1934–1936. [DOI] [PubMed] [Google Scholar]
- 11. Mavrogeni S, Gotsis ED, Berdousi E, Ladis V, Verganelakis D, et al.: Myocardial and hepatic T2* magnetic resonance evaluation in ex‐thalassemic patients after bone‐marrow transplantation. Int J Cardiovasc Imaging 2007; 1569–5794. [DOI] [PubMed] [Google Scholar]
- 12. Chacko J, Pennell DJ, Tanner MA, Hamblin TJ, Wonke B, et al.: Myocardial iron loading by magnetic resonance imaging T2* in good prognostic myelodysplastic syndrome patients on long‐term blood transfusions. Br J Haematol 2007; 138: 587–593. [DOI] [PubMed] [Google Scholar]
- 13. Mavrogeni SI, Markussis V, Kaklamanis L, Tsiapras D, Paraskevaidis I, et al.: A comparison of magnetic resonance imaging and cardiac biopsy in the evaluation of heart iron overload in patients with beta‐thalassemia major. Eur J Haematol 2005; 75: 241–247. [DOI] [PubMed] [Google Scholar]
- 14. Konen E, Ghoti H, Goitein O, Winder A, Kushnir T, et al.: No evidence for myocardial iron overload in multitransfused patients with myelodysplastic syndrome using cardiac magnetic resonance T2* technique. Am J Hematol 2007; 82: 1013–1016. [DOI] [PubMed] [Google Scholar]
- 15. Westwood MA, Sheppard MN, Awogbade M, Ellis G, Stephens AD, et al.: Myocardial biopsy and T2* magnetic resonance in heart failure due to thalassaemia. Br J Haematol 2005; 128: 2. [DOI] [PubMed] [Google Scholar]
- 16. Cheong B, Huber S, Muthupillai R, Flamm SD: Evaluation of myocardial iron overload by T2* cardiovascular magnetic resonance imaging. Tex Heart Inst J 2005; 32: 448–449. [PMC free article] [PubMed] [Google Scholar]
- 17. Ghugre NR, Enriquez CM, Gonzalez I, Nelson MD Jr, Coates TD, et al.: MRI detects myocardial iron in the human heart. Magn Reson Med 2006; 56: 681–686. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18. Wood JC, Otto‐Duessel M, Aguilar M, Nick H, Nelson MD, et al.: Cardiac iron determines cardiac T2*, T2, and T1 in the gerbil model of iron cardiomyopathy. Circulation 2005; 112: 535–543. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19. Tanner MA, Galanello R, Dessi C, Smith GC, Westwood MA, et al.: A randomized, placebo‐controlled, double‐blind trial of the effect of combined therapy with deferoxamine and deferiprone on myocardial iron in thalassemia major using cardiovascular magnetic resonance. Circulation 2007; 115: 1876–1884. [DOI] [PubMed] [Google Scholar]