Global longitudinal strain by cardiac magnetic resonance is associated with cardiac iron and complications in beta-thalassemia major patients

Background The aim of this cross-sectional study was to investigate the association of left ventricular (LV) strain parameters with demographics, clinical data, cardiovascular magnetic resonance (CMR) findings, and cardiac complications (heart failure and arrhythmias) in patients with β-thalassemia major (β-TM). Method We considered 266 β-TM patients (134 females, 37.08 ± 11.60 years) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project and 80 healthy controls (50 females, mean age 39.77 ± 11.29 years). The CMR protocol included cine images for the assessment of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) using feature tracking (FT) and for the quantification of LV function parameters, the T2* technique for the assessment of myocardial iron overload, and late gadolinium enhancement (LGE) technique. Results In comparison to the healthy control group, β-TM patients showed impaired GLS, GCS, and GRS values. Among β-TM patients, sex was identified as the sole independent determinant of all LV strain parameters. All LV strain parameters displayed a significant correlation with LV end-diastolic volume index, end-systolic volume index, mass index, and ejection fraction, and with the number of segments exhibiting LGE. Only GLS exhibited a significant correlation with global heart T2* values and the number of segments with T2* < 20 ms. Patients with cardiac complications exhibited significantly impaired GLS compared to those without cardiac complications. Conclusion In patients with β-TM, GLS, GCS, and GRS were impaired in comparison with control subjects. Among LV strain parameters, only GLS demonstrated a significant association with cardiac iron levels and complications

Preferential patterns of myocardial iron deposit by multislice multiecho T2* CMR in thalassemia major patients

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Effective Cardiac Index and Systemic-Pulmonary Collaterals Evaluated by Cardiac Magnetic Resonance Late After Fontan Palliation

The regulation of cardiac output in the Fontan circuit is not completely understood. Systemic-pulmonary collaterals (SPCs) are frequent in patients with univentricular heart, and their clinical significance and management remain controversial. The aims of our study were to identify factors associated with SPCs' flow at late follow-up after Fontan and evaluate the relation between SPCs flow (QSPCs) and the effective cardiac index (CI). From our cardiac magnetic resonance database, we identified all Fontan patients with a complete set of flow measurements allowing calculation of QSPCs and effective CI. QSPCs was calculated as (left pulmonary veins flow + right pulmonary veins flow) â (right pulmonary artery flow + left pulmonary artery flow). Effective CI was calculated as (Aortic flow (QAo) â QSPCs)/BSA. Medical, surgical history, and clinical status were recorded. Sixty-four post-Fontan patients (36 male; mean age 19 ± 10 years) were included in the study. Median QSPCs was 0.7 L/min/m2 (interquartile [IQ] range 0.386â0.983) accounting for a median of 21% (IQ range 13â28) of aortic flow. The effective CI in our population was 2.4 ± 0.6 L/min/m2. QSPCs inversely correlate with left pulmonary artery area (r = â0.37, p = 0.004) and total antegrade pulmonary flow (r = â0.32, p = 0.01). QSPCs correlate with indexed aortic flow (r = 0.6, p <0.001) and inversely correlate with effective CI (r = â0.39, p = 0.002). Effective CI inversely correlates with age at study and age at the Fontan palliation (r = â0.35, p = 0.005, and r = â0.29, p = 0.02, respectively) and positively with ventricular ejection fraction (r = 0.3, p = 0.01). In conclusion, SPCs are common in Fontan patients, correlate inversely with effective CI, and are associated with a reduced antegrade pulmonary flow. In cardiac magnetic resonance evaluation of post-Fontan patients, effective CI should be taken into account rather than the total CI