Myocardial Iron Loading in Patients with Thalassemia Major on Deferoxamine Chelation

Authors
M. A. Tanner, MB, MRCP, R. Galanello, MD, C. Dessi, MD, M. A. Westwood, MD, MRCP, G. C. Smith, MSc, S. V. Nair, MB, MRCP, L. J. Anderson, MD, MRCP, J. M. Walker, MD, FRCP, and D. J. Pennell, MD, FRCP

Journal
Journal of Cardiovascular Magnetic Resonance (2006) 8, 543–547

Background
Cardiac failure due to iron overload in the heart is the leading cause of death in thalassaemia major patients. This study was performed to evaluate the prevalence of myocardial iron overload as well as decreased heart function in thalassaemia major patients maintained on deferoxamine therapy.

Methods
Using a Cardiac Magnetic Resonance (CMR) scanner, 167 Thalassaemia Major patients were assessed for myocardial iron loading, B-natriuretic peptide (BNP), and ferritin. In patients with myocardial iron loading, CMR assessments of ventricular function were also made.

Summary
65% of the patients on deferoxamine therapy were found to have cardiac iron overload, and 13% of patients had a T2* value of <8ms, indicating they were at risk for serious cardiac complications. A decrease in ventricular function was also observed in proportion to a decrease in T2* value.

In addition, there was no correlation found between liver iron load and cardiac iron load, as mentioned by T2*, indicating that iron concentrations do not accurately predict myocardial iron load.

These findings show that two thirds of thalassaemia major patients treated with conventional deferoxamine therapy may be at risk of serious cardiac complications.

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