Alicia Maceira

Dudley J Pennell

Francisco Alpendurada

Gillian C Smith

J Malcolm Walker

John B Porter

John-Paul Carpenter

Monica Deac

Paul Kirk

Winston Banya

Journal of Cardiovascular Magnetic Resonance

Springer - Publisher Connector

BioMed Central
Journal of Cardiovascular Magnetic 
Resonance
ssOpen AccePoster presentation
Normalized ranges for right ventricular volumes and 
function in thalassemia major
John-Paul Carpenter*1, Francisco Alpendurada1, Monica Deac1, Paul Kirk1, 
Alicia Maceira1, J Malcolm Walker2, John B Porter2, Winston Banya1, 
Gillian C Smith1 and Dudley J Pennell1
Address: 1Royal Brompton and Harefield NHS Trust, London, UK and 2University College London, London, UK
* Corresponding author    
Introduction
Beta-thalassemia major (TM) patients have a severe ane-
mia requiring lifelong transfusion to allow normal devel-
opment and prolong survival. Left ventricular volumes
and ejection fraction in these patients differ from the nor-
mal population because of chronically increased cardiac
output, and this can affect the interpretation of scan
results. However, normal ranges for RV parameters and
function are unknown.
Purpose
To define the normal ranges for RV volumes and ejection
fraction (EF) in non-iron overloaded transfusion-depend-
ent TM patients.
Methods
Our study population consisted of 80 transfusion-
dependent TM patients (40 males and 40 females) with
no evidence of cardiac iron loading (cardiac T2* > 20 ms).
Only those over 18 with no evidence of significant cardi-
opulmonary pathology were included. To control for dif-
ferent iron chelators and possible treatment effect,
patients included in the analysis were presenting for their
first scan and were only taking a single chelation agent
(deferoxamine). Forty age- and sex-matched patients
acted as controls. RV volumes and EF were measured from
short-axis steady-state free precession cine images using
CMRtools (Cardiovascular Imaging Solutions, London).
Groups were compared using a two-tailed, two sample t-
test.
Results
Both groups were well matched with respect to age and
gender but the TM patients (as would be expected) had
significantly lower height, weight and body surface area
than non-anemic controls (P < 0.05). Body mass index
was equivalent in females but slightly lower in male TM
patients compared to controls. TM patients had a signifi-
cantly higher resting heart rate (P < 0.05). Mean RV end-
diastolic volume index was higher in TM patients than
controls (but this did not reach significance for females).
Although the absolute value for mean RV end-systolic vol-
ume index was lower in TM patients, there was no signifi-
cant difference for either gender. In both males and
females, the TM patients had a higher RV stroke volume,
RVEF, cardiac output and cardiac output index (P < 0.05).
See Tables 1, 2, 3 and Figure 1.
Conclusion
Our findings have confirmed that not only LV but also RV
'normal ranges' differ between patients with TM and nor-
mal, non-anemic controls. This partly explains why ven-
tricular impairment appears to occur late in iron overload
cardiomyopathy. The lower limit of RVEF in TM patients
is significantly higher than in normal controls and there-
fore, if the wrong reference range is used, a cardiomyopa-
thy may exist even though the RVEF appears to be
'normal'. It is important to take this into account when
assessing RV function in TM patients.
from 13th Annual SCMR Scientific Sessions
Phoenix, AZ, USA. 21-24 January 2010
Published: 21 January 2010
Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P279 doi:10.1186/1532-429X-12-S1-P279
<supplement> <title> <p>Abstracts of the 13<sup>th </sup>Annual SCMR Scientific Sessions - 2010</p> </title> <note>Meeting abstracts - A single PDF containing all abstracts in this Supplement is available <a href="http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-full.pdf">here</a>.</note> <url>http://www.biomedcentral.com/content/files/pdf/1532-429X-11-S1-info</url> </supplement>
This abstract is available from: http://jcmr-online.com/content/12/S1/P279
© 2010 Carpenter et al; licensee BioMed Central Ltd. Page 1 of 2
(page number not for citation purposes)
Journal of Cardiovascular Magnetic Resonance 2010, 12(Suppl 1):P279 http://jcmr-online.com/content/12/S1/P279Table 1: Right ventricular parameters normalised to body surface area for males
Males TM patients Mean ± SD [95% CI] Controls Mean ± SD [95% CI] P value
RVEDVI (mL/m2) 97.7 ± 17.1 [92.2-103.2] 88.4 ± 11.2 [83.2-93.7] 0.03
RVESVI (mL/m2) 33.1 ± 8.0 [30.5-35.6] 33.8 ± 5.0 [31.4-36.1] 0.73
RVSVI (mL/m2) 64.4 ± 11.1 [60.9-68.0] 54.7 ± 10.3 [49.9-59.5] 0.002
RVEF (%) 66.2 ± 4.1 [64.8-67.5] 61.6 ± 6.0 [58.8-64.4] 0.001
CO (L/min) 7.8 ± 1.9 [7.2-8.4] 6.6 ± 1.6 [5.8-7.4] 0.02
COI (L/min/m2) 4.7 ± 1.0 [4.4-5.1] 3.4 ± 0.7 [3.0-3.7] < 0.001
RV: right ventricular. RVEDVI: RV end diastolic volume index. RVESVI: RV end systolic volume index. RVSVI: RV stroke volume index. RVEF: RV 
ejection fraction. CO: cardiac output. COI: cardiac output index.
Table 2: Right ventricular parameters normalized to body surface area for females
Females TM patients Mean ± SD [95% CI] Controls Mean ± SD [95% CI] P value
RVEDVI (mL/m2) 86.3 ± 13.6 [81.9-90.6] 80.3 ± 12.7 [74.3-86.3] 0.11
RVESVI (mL/m2) 29.1 ± 7.2 [26.8-31.4] 30.3 ± 8.6 [26.3-34.3] 0.56
RVSVI (mL/m2) 57.3 ± 9.3 [54.3-60.2] 50.0 ± 7.8 [46.3-53.6] 0.004
RVEF (%) 66.2 ± 5.2 [64.6-67.9] 62.6 ± 6.4 [59.6-65.5] 0.02
CO (L/min) 6.8 ± 1.7 [6.2-7.3] 5.5 ± 1.5 [4.7-6.2] 0.004
COI (L/min/m2) 4.5 ± 0.8 [4.2-4.8] 3.2 ± 0.8 [2.9-3.6] < 0.001
Table 3: Patient demographics
Males Females
TM patients Mean ± 
SD
Controls Mean ± SD P value TM patients Mean ± 
SD
Controls Mean ± SD P value
Age (years) 30 ± 8 30 ± 5 0.94 30.4 ± 8.5 30.1 ± 5.0 0.88
Height (m) 1.65 ± 0.1 1.80 ± 0.09 < 0.001 1.54 ± 8.9 1.67 ± 9.2 < 0.001
Weight (kg) 59.1 ± 8.9 75.8 ± 9.9 < 0.001 53.3 ± 10.1 61.4 ± 11.3 0.006
BMI (kg/m2) 21.9 ± 3.1 23.6 ± 3.1 0.048 22.5 ± 4.5 22.0 ± 2.8 0.68
BSA (m2) 1.64 ± 0.16 1.94 ± 0.15 < 0.001 1.50 ± 0.15 1.68 ± 0.18 < 0.001
Heart rate (min-1) 72.7 ± 10.4 64.0 ± 9.5 < 0.05 78.8 ± 10.1 64.8 ± 13.6 < 0.001
Figure 1Page 2 of 2
(page number not for citation purposes)


Normalized ranges for right ventricular volumes and function in thalassemia major

file:///data/core-remote/dit/data/Springer-OA/pdf/b69/aHR0cDovL2xpbmsuc3ByaW5nZXIuY29tLzEwLjExODYvMTUzMi00MjlYLTEyLVMxLVAyNzkucGRm.pdf

Normalized ranges for right ventricular volumes and function in thalassemia major

Abstract

Similar works

Full text

Available Versions

Springer - Publisher Connector