[Show abstract][Hide abstract] ABSTRACT: Our aim was to evaluate the correlation between myocardial fibrosis detected using the late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) technique and chronic hepatitis C (CHC) in a large, retrospective, multicentre cohort of thalassemia major patients.
LGE images were acquired in 434 thalassemia major patients (233 men, 31 ± 9 years) enrolled in the MIOT (Myocardial Iron Overload in Thalassemia) study. Hepatitis C virus (HCV)-RNA tests were sensitive to detect more than 50 copies/ml.
No patient manifested moderate/severe adverse events associated with the use of Gadobutrol. Myocardial fibrosis was detected in 90 (21%) patients. Among the 312 patients tested for HCV-RNA, there was a significant correlation between the presence of myocardial fibrosis and CHC (P = 0.011). Among the 62 patients with myocardial fibrosis tested for HCV-RNA, we found a significantly higher prevalence of diabetes mellitus in CHC patients versus the no-CHC patients (P = 0.049).
Our findings support the use of the LGE CMR approach well tolerated in the thalassemia major patients with CHC. HCV infection can be involved in the pathogenesis of myocardial fibrosis through both myocarditis directly and the pancreas and liver damage with the development of diabetes indirectly. These patients could therefore benefit from cardioactive drugs and therapeutic interventions directed towards the eradication of virus.
Journal of Cardiovascular Medicine 06/2015; 16(10). DOI:10.2459/JCM.0000000000000278 · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To assess the transferability of the magnetic resonance imaging (MRI) multislice multiecho T2(*) technique for global and segmental measurement of iron overload in thalassemia patients.
Multiecho T2(*) sequences were installed on six MRI scanners. Five healthy subjects (n = 30) were scanned at each site; five thalassemia major (TM) patients were scanned at the reference site and were rescanned locally (n = 25) within 1 month. T2(*) images were analyzed using previously validated software.
T2(*) values of healthy subjects showed intersite homogeneity. On TM patients, for global heart T2(*) values the correlation coefficient was 0.97, coefficients of variation (CoV(s)) ranged from 0.04-0.12, and intraclass coefficients (ICC(s)) ranged from 0.94-0.99. The mean CoV and ICC for segmental T2(*) distribution were 0.198 and 88, respectively.
The multislice multiecho T2(*) technique is transferable among scanners with good reproducibility.
Journal of Magnetic Resonance Imaging 07/2009; 30(1):62-8. DOI:10.1002/jmri.21781 · 3.21 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To build and evaluate a national network able to improve the care of thalassemia, a genetic disorder in haemoglobin synthesis often associated with iron accumulation in a variety of organs, due to the continuous blood transfusions.
The MIOT (Myocardial Iron Overload in Thalassemia) network is constituted by thalassemia and magnetic resonance imaging (MRI) centers. Thalassemia centers are responsible for patient recruitment and collection of anamnestic and clinical data. MRI centers have been equipped with a standardized acquisition technique and an affordable workstation for image analysis. They are able to perform feasible and reproducible heart and liver iron overload assessments for a consistent number of thalassemia patients in a robust manner. All centers are linked by a web-based network, configured to collect and share patient data.
On 30th March 2008, 695 thalassemia patients were involved in the network. The completion percentage of the patient records in the database was 85+/-6.5%. Six hundred and thirteen patients (88%) successfully underwent MRI examination. Each MRI center had a specific absorption capacity that remained constant over time, but the network was capable of sustaining an increasing number of patients due to continuous enrollment of new centers. The patient's comfort, assessed as the mean distance from the patient home locations to the MRI centers, significantly increased during the network's evolution.
The MIOT network seems to be a robust and scalable system in which T2* MRI-based cardiac and liver iron overload assessment is available, accessible and reachable for a significant and increasing number of thalassemia patients in Italy (about 420 per year), reducing the mean distance from the patient locations to the MRI sites from 951km to 387km. A solid, wide and homogeneous database will constitute an important scientific resource, shortening the time scale for diagnostic, prognostic and therapeutical evidence-based research on the management of thalassemia disease.
International Journal of Medical Informatics 05/2009; 78(8):503-12. DOI:10.1016/j.ijmedinf.2009.02.011 · 2.00 Impact Factor