Changes in CMR Parameters and Prediction of Cardiac Complications in Thalassemia Major: Fibrosis Tells Us More than Iron.
Antonella Meloni1, Laura Pistoia1, Pietro Giuliano2, Nicola Giunta2, Nicolò Schicchi3, Emanuele Grassedonio4, Stefania Renne5, Vincenzo Positano1, Lorella Pitrolo6, Maria Grazia Roberti7, Paola Maria Grazia Sanna8, Filippo Cademartiri1, and Alessia Pepe1
1Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy, 2"ARNAS" Civico, Di Cristina Benfratelli, Palermo, Italy, 3Azienda Ospedaliero-Universitaria Ospedali Riuniti "Umberto I-Lancisi-Salesi", Ancona, Italy, 4Policlinico "Paolo Giaccone", Palermo, Italy, 5Presidio Ospedaliero “Giovanni Paolo II”, Lamezia Terme (CZ), Italy, 6Ospedale "V. Cervello", Palermo, Italy, 7Azienda Ospedaliero-Universitaria OO.RR. Foggia, Foggia, Italy, 8Azienda Ospedaliero-Universitaria di Sassari, Sassari, Italy
Seven-hundred and nine patients with thalassemia major who performed a baseline and a 1st follow-up CMR scan after 18 months were followed prospectively in order to evaluate the predictive value of changes in CMR parameters (myocardial iron, biventricular function, and replacement myocardial fibrosis) for cardiac complications. During a mean follow-up of 89.4±33.3 months, cardiac events (heart failure, arrhythmias, and pulmonary hypertension) were recorded in 7.1% of patients. In the univariate Cox regression analysis, cardiac iron clearance and replacement myocardial fibrosis were identified as univariate prognosticators but in the multivariate analysis only myocardial fibrosis remained an independent predictor factor.
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