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Saadatifar H, Niayeshfar A, Mard-Soltani M, Bahrampour E, Khalili S, Alinezhad Dezfuli D, Pouriamehr S. The correlation of cardiac biomarkers and myocardial iron overload based on T2* MRI in major beta-thalassemia. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:833-840. [PMID: 34727252 DOI: 10.1007/s10554-021-02458-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/26/2021] [Indexed: 10/19/2022]
Abstract
Cardiac hemosiderosis is the primary factor to derive the pathogenesis of cardiac dysfunction in patients with transfusion dependent thalassemia. Biomarkers assessment along with T2 * MRI study could be employed to evaluate the severity of iron deposition-related damage and determination of the diagnostic and prognostic value of these inflammatory factors. The study was conducted on 62 patients (12-44 years old) with major thalassemia. The patients were under regular blood transfusion and they had no signs of cardiac defects, and chronic diseases. The serum levels of inflammatory factors (NT-proBNP, CRP, Copeptin HS) were determined before routine transfusion. Cardiac iron overload was assessed by T2* MRI (within the last three months), and T2* lower than 20 ms was considered as cardiac siderosis. The obtained results were analyzed using statistical methods. 92% of patients showed an increased level of hs-CRP (> 2 µg/dL). All cases showed increased levels of NT-proBNP (> 150 pg/mL). Only 29% of subjects showed high level of Copeptin, 25.8% of patients demonstrated cardiac siderosis based on the T2* MRI (< 20 ms) results. The serum levels of inflammatory factors were not significantly correlated with cardiac siderosis. Given the obtained results, it could be deduced that the serum levels of inflammatory factors could not be exploited for early detection of cardiac siderosis in major beta-thalassemia patients.
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Affiliation(s)
- Hakimeh Saadatifar
- Department of Echocardiography, Dezful University of Medical Sciences, Dezful, Iran
| | - Arezoo Niayeshfar
- Department of Echocardiography, Dezful University of Medical Sciences, Dezful, Iran
| | - Maysam Mard-Soltani
- Department of Laboratory Sciences, Student Research Committee, Dezful University of Medical Sciences, Dezful, Iran.
| | - Ehsan Bahrampour
- Department of Epidemiology, Dezful University of Medical Sciences, Dezful, Iran
| | - Saeed Khalili
- Department of Biology Sciences, Shahid Rajaee Teacher Training University, Tehran, Iran
| | | | - Somayeh Pouriamehr
- Department of Laboratory Sciences, Dezful University of Medical Sciences, Dezful, Iran
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Snel GJH, van den Boomen M, Hernandez LM, Nguyen CT, Sosnovik DE, Velthuis BK, Slart RHJA, Borra RJH, Prakken NHJ. Cardiovascular magnetic resonance native T 2 and T 2* quantitative values for cardiomyopathies and heart transplantations: a systematic review and meta-analysis. J Cardiovasc Magn Reson 2020; 22:34. [PMID: 32393281 PMCID: PMC7212597 DOI: 10.1186/s12968-020-00627-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 04/16/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The clinical application of cardiovascular magnetic resonance (CMR) T2 and T2* mapping is currently limited as ranges for healthy and cardiac diseases are poorly defined. In this meta-analysis we aimed to determine the weighted mean of T2 and T2* mapping values in patients with myocardial infarction (MI), heart transplantation, non-ischemic cardiomyopathies (NICM) and hypertension, and the standardized mean difference (SMD) of each population with healthy controls. Additionally, the variation of mapping outcomes between studies was investigated. METHODS The PRISMA guidelines were followed after literature searches on PubMed and Embase. Studies reporting CMR T2 or T2* values measured in patients were included. The SMD was calculated using a random effects model and a meta-regression analysis was performed for populations with sufficient published data. RESULTS One hundred fifty-four studies, including 13,804 patient and 4392 control measurements, were included. T2 values were higher in patients with MI, heart transplantation, sarcoidosis, systemic lupus erythematosus, amyloidosis, hypertrophic cardiomyopathy (HCM), dilated cardiomyopathy (DCM) and myocarditis (SMD of 2.17, 1.05, 0.87, 1.39, 1.62, 1.95, 1.90 and 1.33, respectively, P < 0.01) compared with controls. T2 values in iron overload patients (SMD = - 0.54, P = 0.30) and Anderson-Fabry disease patients (SMD = 0.52, P = 0.17) did both not differ from controls. T2* values were lower in patients with MI and iron overload (SMD of - 1.99 and - 2.39, respectively, P < 0.01) compared with controls. T2* values in HCM patients (SMD = - 0.61, P = 0.22), DCM patients (SMD = - 0.54, P = 0.06) and hypertension patients (SMD = - 1.46, P = 0.10) did not differ from controls. Multiple CMR acquisition and patient demographic factors were assessed as significant covariates, thereby influencing the mapping outcomes and causing variation between studies. CONCLUSIONS The clinical utility of T2 and T2* mapping to distinguish affected myocardium in patients with cardiomyopathies or heart transplantation from healthy myocardium seemed to be confirmed based on this meta-analysis. Nevertheless, variation of mapping values between studies complicates comparison with external values and therefore require local healthy reference values to clinically interpret quantitative values. Furthermore, disease differentiation seems limited, since changes in T2 and T2* values of most cardiomyopathies are similar.
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Affiliation(s)
- G J H Snel
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - M van den Boomen
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - L M Hernandez
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - C T Nguyen
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
| | - D E Sosnovik
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, 149 13th Street, Charlestown, MA, 02129, USA
- Division of Health Sciences and Technology, Harvard-MIT, 7 Massachusetts Avenue, Cambridge, MA, 02139, USA
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Biomedical Photonic Imaging, University of Twente, Dienstweg 1, 7522 ND, Enschede, The Netherlands
| | - R J H Borra
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - N H J Prakken
- Department of Radiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
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Red blood cell alloimmunisation in transfusion-dependent thalassaemia: a systematic review. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2019; 17:4-15. [PMID: 30653458 DOI: 10.2450/2019.0229-18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 12/06/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic red blood cell transfusion is the first-line treatment for severe forms of thalassaemia. This therapy is, however, hampered by a number of adverse effects, including red blood cell alloimmunisation. The aim of this systematic review was to collect the current literature data on erythrocyte alloimmunisation. MATERIALS AND METHODS We performed a systematic search of the literature which identified 41 cohort studies involving 9,256 patients. RESULTS The prevalence of erythrocyte alloimmunisation was 11.4% (95% CI: 9.3-13.9%) with a higher rate of alloimmunisation against antigens of the Rh (52.4%) and Kell (25.6%) systems. Overall, alloantibodies against antigens belonging to the Rh and Kell systems accounted for 78% of the cases. A higher prevalence of red blood cell alloimmunisation was found in patients with thalassaemia intermedia compared to that among patients with thalassaemia major (15.5 vs 12.8%). DISCUSSION Matching transfusion-dependent thalassaemia patients and red blood cell units for Rh and Kell antigens should be able to reduce the risk of red blood cell alloimmunisation by about 80%.
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Kautsar A, Advani N, Andriastuti M. N-terminal-pro-b-type natriuretic peptide levels and cardiac hemosiderosis in adolescent β-thalassemia major patients. Ann Pediatr Cardiol 2019; 12:32-37. [PMID: 30745767 PMCID: PMC6343373 DOI: 10.4103/apc.apc_49_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Iron-induced cardiomyopathy remains the leading cause of mortality in patients with β-thalassemia major. Iron overload cardiomyopathy, which may be reversible through iron chelation, is characterized by early diastolic dysfunction. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker of diastolic dysfunction. Aim: The aim of the study is to evaluate the diagnostic value of NT-proBNP as a surrogate marker of iron overload examined with magnetic resonance imaging T2-star (MRI T2*). Methods: Sixty-eight β-thalassemia major patients (10–18 years) with no signs of heart failure underwent NT-proBNP measurement before routine transfusion. All participants prospectively underwent cardiac MRI T2* examination within 3 months (median 19 days). Patients were divided as cardiac hemosiderosis (cardiac MRI T2* <20 ms) and nonhemosiderosis (cardiac MRI T2* >20 ms). Results: Of 68 patients, the male-to-female ratio was 1:1.1 and the median age was 14.1 years (range: 10–17.8 years). NT-proBNP levels were not different between hemosiderosis and nonhemosiderosis patients (P = 0.233). Further receiver operating characteristic analysis resulted in no significant correlation of NT-proBNP and MRI T2* (area under the curve 0.393, P = 0.233). Conclusion: Measurement of NT-proBNP levels cannot be used for early detection of cardiac iron overload in adolescent with β-thalassemia major.
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Affiliation(s)
- Ahmad Kautsar
- Department of Child Health, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Najib Advani
- Department of Child Health, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Murti Andriastuti
- Department of Child Health, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Hua C, Huang Y, Su Y, Bu J, Tao H. Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure. Braz J Med Biol Res 2017; 50:e6355. [PMID: 28953989 PMCID: PMC5609602 DOI: 10.1590/1414-431x20176355] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 06/22/2017] [Indexed: 04/19/2023] Open
Abstract
Chronic heart failure (CHF) is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM) on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of heart failure index and short form health survey 12, respectively. Further, cardiac function was assessed by measuring left ventricular ejection fraction (LVEF) and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), and by the 6-min walking test. Clinical and demographic characteristics of patients in the control and CCM groups were statistically equivalent. Compared with usual care, CCM significantly enhanced self-care abilities of patients with CHF, including self-care maintenance, self-care management and self-care confidence (all P<0.05). The physical and mental quality of life was also significantly improved by CCM (P<0.01 or P<0.05). Compared with usual care, CCM significantly increased the LVEF (P<0.01), decreased the NT-proBNP level (P<0.01), and enhanced exercise capacity (P<0.001). In conclusion, CCM improved the self-care, quality of life and cardiac function of patients with CHF compared with usual care.
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Affiliation(s)
- C.Y. Hua
- Department of Hematology and Rheumatology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Y. Huang
- Department of Cardiothoracic Surgery, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - Y.H. Su
- Department of General Surgery I, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - J.Y. Bu
- Department of General Surgery I, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
| | - H.M. Tao
- Department of Nursing, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, Guangdong, China
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Singh MM, Kumar R, Tewari S, Agarwal S. Determining Nt-proBNP Levels with Diastolic Dysfunction in Thalassemia Major Patients. J Pediatr Genet 2017; 6:222-226. [PMID: 29142764 DOI: 10.1055/s-0037-1603193] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/10/2017] [Indexed: 12/19/2022]
Abstract
Beta thalassemia is an autosomal, recessive disorder, characterized by ineffective erythropoiesis. Chronic transfusions and inability of body to eliminate iron lead to an iron overload, thereby causing damage to heart. Natriuretic peptides (NPs) are produced within the heart, which are then released into the circulation in response to ventricular wall stress. We, therefore, aimed to study the relation between ventricular dysfunction and N-terminal pro-B-type natriuretic peptides (NT-proBNPs). We enrolled 105 patients with increased serum ferritin levels and echocardiography was performed. We collected blood samples and NT-proBNP levels were measured in them. Though we found that the studied group had no significant difference in the mean serum NT-proBNP levels, in patients with or without hypertrophy ( n = 37, p = 0.992), the NT-proBNP levels were found to be significantly increased in patients with diastolic dysfunction ( n = 24, p < 0.0001 with mean values of 577.67 ± 122.01 and 456.50 ± 48.40 pg/mL in patients with and without diastolic dysfunction, respectively). The NT-proBNP levels correlated well with the echocardiography indices, such as left ventricular end-systolic diameter (LVESD), ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/E' ratio), and ratio of the early (E) to late (A) ventricular filling velocities (E/A ratio), and were found to have significant positive correlation with the serum ferritin levels. The NT-proBNP levels correlated significantly with diastolic dysfunction; thus, serum ferritin levels could be useful for assessing the diastolic dysfunction in patients with beta thalassemia.
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Affiliation(s)
- Mable Misha Singh
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar
- Department of Genetics, National Institute for Research in Tribal Health, Indian Council of Medical Research, Jabalpur, Madhya Pradesh, India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sarita Agarwal
- Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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