Among patients with thalassemia major (TM), including late gadolinium enhancement (LGE) in T2* cardiovascular magnetic resonance (CMR)-based evaluations of iron-induced heart failure may improve prognostic stratification, according to research presented at the 64th American Society of Hematology (ASH) Annual Meeting and Exposition in New Orleans, Louisiana.
Since the introduction of CMR, death in patients with TM due to HF has decreased, as clinicians have been better equipped to detect myocardial iron overload (MIO).
It is, however, recognized that a number of factors influence HF rates among patients with TM. For this study, researchers evaluated whether a multiparametric CMR test, which includes an LGE technique, improves prognostic estimation of HF risk among patients with TM.
The authors evaluated data from 1398 patients with TM who had undergone a baseline CMR exam at a health care site within the Myocardial Iron Overload in Thalassemia network. All patients were White, none had a history of HF, the mean age was 30.8 years, and 51.9% of patients were female sex.
The mean follow-up period was 4.83 years; 1% had died of HF during follow-up. By this point, 49.1% of patients had switched their chelation regimen, which included both dose or frequency modifications and therapy switch. Analysis showed that patients who changed chelation regimen were more likely to have a global heart T2* value of less than 20 ms (33.2% vs 19.7% among those who did not switch regimen; P <.0001).
Univariate analysis showed that a global heart T2* value of less than 20 ms had a hazard ratio (HR) for HF-related mortality of 4.04 (95% CI, 1.28-12.75; P =.017). Ventricular dysfunction (HR, 3.3; 95% CI, 1.05-10.41; P =.041), ventricular dilation (HR, 6.63; 95% CI, 1.99-22.04; P =.002), and myocardial fibrosis (HR, 4.19; 95% CI, 1.28-13.72; P =.018) were each predictors of mortality.
The authors used this univariate analysis to construct a 4–CMR predictor test for HF-related mortality. Analysis of this test showed that having all 4 markers was a strong predictor of mortality (HR, 89.93; 95% CI, 5.62-1439.46; P =.001).
“Importantly, when the four CMR indices were evaluated in combination, they fine-tuned the prognostic stratification of TM patients,” the authors noted in their presentation. “Hence, the findings of the present study promote the exploitation of the full potential of CMR, including LGE, for a better risk stratification of TM patients.”
Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Meloni A, Pistoia L, Maggio A, et al. Cardiac magnetic resonance predicts heart failure mortality in patients with thalassemia major. Presented at ASH 2022. December 10-13, 2022. Abstract 2354.