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Prevalence and clinical-Instrumental correlates of myocardial scarring by delayed enhancement cardiovascular magnetic resonance in thalassemia major
  1. Alessia Pepe (alessia.pepe{at}ifc.cnr.it)
  1. Institute of Clinical Physiology, “G. Monasterio Foundation”/CNR, Italy
    1. Vincenzo Positano (positano{at}ifc.cnr.it)
    1. Institute of Clinical Physiology, “G. Monasterio Foundation”/CNR, Italy
      1. Marcello Capra (mcapra{at}inwind.it)
      1. Pediatria per le Emopatie Ereditarie, G. Di Cristina Hospital ARNAS, Italy
        1. Aurelio Maggio (aureliomaggio{at}virgilio.it)
        1. Ematologia II con Talassemia, “V. Cervello” Hospital, Italy
          1. Carmela Lo Pinto (malthal{at}tiscali.it)
          1. Pediatria II per le Emopatie Ereditarie, Villa Sofia-CTO Hospital, Italy
            1. Anna Spasiano (spasiano.anna{at}tiscali.it)
            1. Centro per la Cura delle Microcitemie, Cardarelli Hospital, Italy
              1. Gianluca Forni (gianluca.forni{at}galliera.it)
              1. Centro microcitemia ed anemie congenite, Galliera Hospital, Italy
                1. Giorgio Derchi (derchi{at}galliera.it)
                1. Struttura Complessa di Cardiologia, Galliera Hospital, Italy
                  1. Brunella Favilli (brunella.favilli{at}ifc.cnr.it)
                  1. Institute of Clinical Physiology, “G. Monasterio Foundation”/CNR, Italy
                    1. Giuseppe Rossi (rossigi{at}ifc.cnr.it)
                    1. Institute of Clinical Physiology, “G. Monasterio Foundation”/CNR, Italy
                      1. Eliana Cracolici (eliana.cracolici{at}gmail.com)
                      1. Department of Radiology, University of Palermo, Italy
                        1. Massimo Midiri (massimomidiri{at}hotmail.com)
                        1. Department of Radiology, University of Palermo, Italy
                          1. Massimo Lombardi (lomass{at}ifc.cnr.it)
                          1. Institute of Clinical Physiology, “G. Monasterio Foundation”/CNR, Italy

                            Abstract

                            Background: Cardiovascular Magnetic Resonance (CMR) by delayed enhancement (DE) has proven to visualize myocardial scarring, but no dedicated studies are available in thalassemia major.

                            Objective: Aim of our study was to investigate the prevalence, extent, clinical and instrumental correlates of myocardial fibrosis or necrosis by DE CMR in thalassemia major patients.

                            Patients: 115 thalassemia major consecutively examined at our MRI Laboratory.

                            Methods: DE images were acquired to quantify myocardial scarring. Myocardial iron overload was determined by multislice multiecho T2*. Cine images were obtained to evaluate biventricular function.

                            Results: DE areas were present in 28/115 patients (24%). Extent of DE was 3.9±2.4 %. In 26 patients the location of fibrosis was not specific and patchy distribution was prevalent. Two patients showed transmural DE following coronary distribution. The DE group was significantly older than the no-DE group (31±7.7 years versus 26±7.7 years, P=0.004). DE correlated with cardiac risk factors (P=0.01), history of cardiac complications (P=0.001), and anti-HCV antibodies (P=0.04). We did not find significant relation with heart T2* values and biventricular function.

                            A significant correlation was found between the presence of DE and changes in ECG (ECG abnormal in DE group 22/28 patients and in no-DE group 30/87 patients; chi-square 14.9; P=0.0001).

                            Conclusions: In thalassemia patients the significant presence of myocardial fibrosis/necrosis seems to be a time dependent process correlating with cardiovascular risk factors and cardiac complications. Levels of HCV antibodies were significantly higher in the serum of thalassemia patients with myocardial fibrosis/necrosis. ECG-changes showed a good accuracy in predicting myocardial scarring.

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