The use of myocardial T2 mapping using a segmental approach did not provide additional sensitivity over mapping via the standard T2* technique among patients with thalassemia major.

However, segmental mapping was able to detect subclinical myocardial inflammation, according to the report published in the European Heart Journal. Segmental mapping was used to identify focal abnormalities or diffuse tissue changes.

The study evaluated 92 patients with thalassemia using MRI to assess iron overload in the liver, pancreas, and heart. Biventricular function was assessed using cine images and replacement of myocardial fibrosis was evaluated using late gadolinium enhancement (LGE). T2 values were also evaluated in 80 volunteers without thalassemia.

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At baseline, the median age of all 166 patients was 38.3 and 61.4% of patients were female. There were 43.4% of patients who had a splenectomy. The median pretransfusion hemoglobin was 9.72 g/dL and the serum ferritin was a median of 1185.84 ng/dL.

Patients with thalassemia demonstrated significantly higher global heart T2 with a median of 56.34 ms compared with 52.93 ms among the volunteers without thalassemia (P <.0001). Among patients with thalassemia, global heart T2 values were higher in females (P =.017) and increased with age (P =.0012).

Increased T2 values, which indicates myocardial inflammation or edema, was present in 48.8% of patients with thalassemia. Decreased or normal T2 values were present among 6.6% and 44.6% of patients with thalassemia, respectively.

LGE was more common among patients with a reduced global heart T2 value versus an increased T2 (P =.036). In addition, segments with reduced T2 were also more likely to have LGE (P =.045). LGE was positive among 42.7% of the 96 patients with images. Of these, 73.2% had 2 or more foci present.

There was no difference in biventricular volume, ejection fractions, or left ventricular mass index based on T2 values. Hepatic and pancreatic iron overload was significantly greater among patients with reduced T2 values.

“T2 mapping does not offer any advantage over the T2* technique in terms of sensitivity for MIO detection but can provide additional information about the subclinical global myocardial inflammatory involvement,” the authors concluded in their report.

Disclosures: This research was supported by Chiesi Farmaceutici SpA and Bayer. One study author declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.

Meloni A, Pistoia L, Positano V, et al. Myocardial tissue characterization by segmental T2 mapping in thalassaemia major: detecting inflammation beyond iron. Eur Heart J. Published online April 18, 2023. doi: 10.1093/ehjci/jead068