Role of Cardiovascular Magnetic Resonance Imaging in Assessment of Myocardial Iron Overload in Thalassemic Patients

Abstract

ardiac siderosis and cardiomyopathy is the main cause of death in thalassemia major patients. That develops as a result of frequent blood transfusion which is considered to be the basic treatment for those patients. The liver is also susceptible to early iron deposition. Liver iron overload, if not diagnosed and properly treated, rapidly develops into cirrhosis. Fortunately, organ haemosiderosis is preventable and reversible in most of cases if early diagnosed and properly treated with iron chelation therapy. Several methods were used to assess iron burden in multitransfused thalassemic patients, including serum iron, transferrin saturation, serum ferritin measurements and liver biopsy. However, the patients always show increased serum iron levels, and complete saturation of transferrin in early years of transfusion. Moreover, serum ferritin has a poor correlation with body iron load. Several factors render ferritin an inaccurate marker of iron overload, as it increases in cases of chronic infectious diseases, malignancies and/or inflammatory disorders. Recently, Cardiac MRI T2* technique has proved to be the most effective, reproducible and non-invasive method for the measurement of both cardiac and hepatic iron load and predict the risk for cardiac dysfunction in patients with thalassemia by assessing the functional parameters concurrently. Moreover, it proved to be useful tool for monitoring and evaluating effectiveness of chelation therapy in these patients allowing its adjustment.