1
|
Meloni A, Pistoia L, Putti MC, Longo F, Corigliano E, Ricchi P, Rossi V, Casini T, Righi R, Renne S, Peritore G, Barbuto L, Positano V, Cademartiri F. Pancreatic iron in pediatric transfusion-dependent beta-thalassemia patients: A longitudinal MRI study. Pediatr Blood Cancer 2024; 71:e30923. [PMID: 38385860 DOI: 10.1002/pbc.30923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND In pediatric transfusion-dependent thalassemia (TDT) patients, we evaluated the prevalence, pattern, and clinical associations of pancreatic siderosis and the changes in pancreatic iron levels and their association with baseline and changes in total body iron balance. PROCEDURE We considered 86 pediatric TDT patients consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Iron overload (IO) was quantified by R2* magnetic resonance imaging (MRI). RESULTS Sixty-three (73%) patients had pancreatic IO (R2* > 38 Hz). Global pancreas R2* values were significantly correlated with mean serum ferritin levels, MRI liver iron concentration (LIC) values, and global heart R2* values. Global pancreas R2* values were significantly higher in patients with altered versus normal glucose metabolism. Thirty-one patients also performed the follow-up MRI at 18 ± 3 months. Higher pancreatic R2* values were detected at the follow-up, but the difference versus the baseline MRI was not significant. The 20% of patients with baseline pancreatic IO showed no pancreatic IO at the follow-up. The 46% of patients without baseline pancreatic IO developed pancreatic siderosis. The changes in global pancreas R2* between the two MRIs were not correlated with baseline serum ferritin levels, baseline, final, and changes in MRI LIC values, or baseline pancreatic iron levels. CONCLUSIONS In children with TDT, pancreatic siderosis is a frequent finding associated with hepatic siderosis and represents a risk factor for myocardial siderosis and alterations of glucose metabolism. Iron removal from the pancreas is exceptionally challenging and independent from hepatic iron status.
Collapse
Affiliation(s)
- Antonella Meloni
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Ricerca Clinica, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maria Caterina Putti
- Dipartimento della Salute della Donna e del Bambino, Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padua, Italy
| | - Filomena Longo
- Unità Operativa Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria "S. Anna,", Cona, Ferrara, Italy
| | | | - Paolo Ricchi
- U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | | | - Tommaso Casini
- SOC Oncologia, Ematologia e Trapianto di Cellule Staminali Emopoietiche, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, Ferrara, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II,", Lamezia Terme, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, "ARNAS" Civico, Di Cristina Benfratelli, Palermo, Italy
| | - Luigi Barbuto
- U.O.C. Radiologia Generale e di Pronto Soccorso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Vincenzo Positano
- Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| |
Collapse
|
2
|
Ricchi P, Meloni A, Pistoia L, Gamberini MR, Cuccia L, Allò M, Putti MC, Spasiano A, Rosso R, Cecinati V, Righi R, Renne S, Peritore G, Vallone A, Positano V, Quaia E, Cademartiri F, Pepe A. Longitudinal prospective comparison of pancreatic iron by magnetic resonance in thalassemia patients transfusion-dependent since early childhood treated with combination deferiprone-desferrioxamine vs deferiprone or deferasirox monotherapy. Blood Transfus 2024; 22:75-85. [PMID: 37146300 PMCID: PMC10812892 DOI: 10.2450/bloodtransfus.485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 01/03/2023] [Indexed: 05/07/2023]
Abstract
BACKGROUND In transfusion-dependent thalassemia patients who started regular transfusions in early childhood, we prospectively and longitudinally evaluated the efficacy on pancreatic iron of a combined deferiprone (DFP) + desferrioxamine (DFO) regimen versus either oral iron chelator as monotherapy over a follow-up of 18 months. MATERIALS AND METHODS We selected patients consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia network who received a combined regimen of DFO+DFP (No.=28) or DFP (No.=61) or deferasirox (DFX) (No.=159) monotherapy between the two magnetic resonance imaging scans. Pancreatic iron overload was quantified by the T2* technique. RESULTS At baseline no patient in the combined treatment group had a normal global pancreas T2* (≥26 ms). At follow-up the percentage of patients who maintained a normal pancreas T2* was comparable between the DFP and DFX groups (57.1 vs 70%; p=0.517).Among the patients with pancreatic iron overload at baseline, global pancreatic T2* values were significantly lower in the combined DFO+DFP group than in the DFP or DFX groups. Since changes in global pancreas T2* values were negatively correlated with baseline pancreas T2* values, the percent changes in global pancreas T2* values, normalized for the baseline values, were considered. The percent changes in global pancreas T2* values were significantly higher in the combined DFO+DFP group than in either the DFP (p=0.036) or DFX (p=0.030) groups. DISCUSSION In transfusion-dependent patients who started regular transfusions in early childhood, combined DFP+DFO was significantly more effective in reducing pancreatic iron than was either DFP or DFX.
Collapse
Affiliation(s)
- Paolo Ricchi
- U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, Naples, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maria R. Gamberini
- Unità Operativa di Day Hospital della Talassemia e delle Emoglobinopatie, Dipartimento della Riproduzione e dell’Accrescimento, Azienda Ospedaliero-Universitaria “S. Anna”, Cona (FE), Italy
| | - Liana Cuccia
- Unità Operativa Complessa Ematologia con Talassemia, ARNAS Civico “Benfratelli-Di Cristina”, Palermo, Italy
| | - Massimo Allò
- Ematologia Microcitemia, Ospedale San Giovanni di Dio-ASP Crotone, Crotone, Italy
| | - Maria C. Putti
- Dipartimento della Salute della Donna e del Bambino, Clinica di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università di Padova, Padua, Italy
| | - Anna Spasiano
- U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, Naples, Italy
| | - Rosamaria Rosso
- Unità Operativa Talassemie ed Emoglobinopatie Azienda Ospedaliero-Universitaria Policlinico “Vittorio Emanuele”, Catania, Italy
| | - Valerio Cecinati
- Struttura Semplice di Microcitemia, Ospedale “SS. Annunziata” ASL Taranto, Taranto, Italy
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero “Giovanni Paolo II”, Lamezia Terme (CZ), Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, ARNAS Civico “Benfratelli-Di Cristina”, Palermo, Italy
| | - Antonino Vallone
- Reparto di Radiologia, Azienda Ospedaliera “Garibaldi” Presidio Ospedaliero Nesima, Catania, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| |
Collapse
|
3
|
Ait-Ali L, Leonardi B, Alaimo A, Baccano G, Bennati E, Bucciarelli V, Clemente A, Favilli S, Ferroni F, Inserra MC, Lovato L, Maiorano A, Marcora SA, Marrone C, Martini N, Mirizzi G, Pasqualin G, Peritore G, Puppini G, Sandrini C, Raimondi F, Secchi F, Spaziani G, Stagnaro N, Salvadori S, Secinaro A, Tchana B, Trocchio G, Galetti D, Pieroni F, Dalmiani S, Bianco F, Festa P. Overcoming Underpowering in the Outcome Analysis of Repaired-Tetralogy of Fallot: A Multicenter Database from the CMR/CT Working Group of the Italian Pediatric Cardiology Society (SICPed). Diagnostics (Basel) 2023; 13:3255. [PMID: 37892076 PMCID: PMC10606799 DOI: 10.3390/diagnostics13203255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/13/2023] [Accepted: 08/19/2023] [Indexed: 10/29/2023] Open
Abstract
Background: Managing repaired tetralogy of Fallot (TOF) patients is still challenging despite the fact that published studies identified prognostic clinical or imaging data with rather good negative predictive accuracy but weak positive predictive accuracy. Heterogeneity of the initial anatomy, the surgical approach, and the complexity of the mechanism leading to dilation and ventricular dysfunction explain the challenge of predicting the adverse event in this population. Therefore, risk stratification and management of this population remain poorly standardized. Design: The CMR/CT WG of the Italian Pediatric Cardiology Society set up a multicenter observational clinical database of repaired TOF evaluations. This registry will enroll patients retrospectively and prospectively assessed by CMR for clinical indication in many congenital heart diseases (CHD) Italian centers. Data collection in a dedicated platform will include surgical history, clinical data, imaging data, and adverse cardiac events at 6 years of follow-up. Summary: The multicenter repaired TOF clinical database will collect data on patients evaluated by CMR in many CHD centers in Italy. The registry has been set up to allow future research studies in this population to improve clinical/surgical management and risk stratification of this population.
Collapse
Affiliation(s)
- Lamia Ait-Ali
- Institute of Clinical Physiology, National Research Institute, 56123 Pisa, Italy; (L.A.-A.); (S.S.)
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| | - Benedetta Leonardi
- Department of Pediatric Cardiology, Cardiac Surgery and Heart Lung Transplantation, Bambino Gesù Children’s Hospital, IRCCS, 00100 Rome, Italy;
| | - Annalisa Alaimo
- U.O.C. Cardiologia Pediatrica, P.O. “G. Di Cristina”, ARNAS Civico, 90123 Palermo, Italy;
| | - Giovanna Baccano
- Department of Pediatric Cardiology, Centro Cardiologico Pediatrico Mediterraneo, 98039 Taormina, Italy;
| | - Elena Bennati
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
| | - Valentina Bucciarelli
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona “Umberto I, G. M. Lancisi, G. Salesi”, 60123 Ancona, Italy;
| | - Alberto Clemente
- Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56123 Pisa, Italy;
| | - Silvia Favilli
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
| | - Francesca Ferroni
- Department of Radiology, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Maria Cristina Inserra
- Department of Radiology, University Hospital Vittorio Emanuele Catania, 95100 Catania, Italy;
| | - Luigi Lovato
- Pediatric and Adult Cardiovascular, Thoraco-Abdominal and Emergency Radiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, 40138 Bologna, Italy;
| | - Antonella Maiorano
- Cardiologia Pediatrica, Ospedale Pediatrico Giovanni XXIII di Bari, Via Amendola 207, 70100 Bari, Italy;
| | - Simona Anna Marcora
- USSD Cardiologia Pediatrica, ASST Grande Ospedale Metropolitano Niguarda, 20126 Milano, Italy;
| | - Chiara Marrone
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| | - Nicola Martini
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| | - Gianluca Mirizzi
- Division of Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, 56123 Pisa, Italy;
| | - Giulia Pasqualin
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy; (G.P.); (F.S.)
| | - Giuseppe Peritore
- U.O.C. di Radiodiagnostica, P.O. “G. Di Cristina”, ARNAS Civico, 90123 Palermo, Italy;
| | - Giovanni Puppini
- Department of Radiology, University of Verona, 37100 Verona, Italy;
| | - Camilla Sandrini
- Division of Cardiology, Department of Medicine, University of Verona, 37100 Verona, Italy;
| | - Francesca Raimondi
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
- Department of Cardiology and Cardiovascular Surgery, Papa Giovanni XXIII Hospital, 24100 Bergamo, Italy
| | - Francesco Secchi
- Department of Radiology, IRCCS Policlinico San Donato, San Donato Milanese, 20097 Milano, Italy; (G.P.); (F.S.)
| | - Gaia Spaziani
- Pediatric Cardiology, Azienda Ospedaliero-Universitaria Meyer, 50100 Florence, Italy; (E.B.); (S.F.); (F.R.); (G.S.)
| | - Nicola Stagnaro
- Radiology Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy;
| | - Stefano Salvadori
- Institute of Clinical Physiology, National Research Institute, 56123 Pisa, Italy; (L.A.-A.); (S.S.)
| | - Aurelio Secinaro
- Advanced Cardiothoracic Imaging Unit, Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, 00100 Rome, Italy;
| | - Bertrand Tchana
- Pediatric Cardiology Unit, General and University Hospital, 43121 Parma, Italy;
| | - Gianluca Trocchio
- Pediatric Cardiology Department, Giannina Gaslini Research Institute and Children Hospital, 16100 Genova, Italy;
| | - Davide Galetti
- Inf Department, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (D.G.); (F.P.); (S.D.)
| | - Federica Pieroni
- Inf Department, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (D.G.); (F.P.); (S.D.)
| | - Stefano Dalmiani
- Inf Department, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (D.G.); (F.P.); (S.D.)
| | - Francesco Bianco
- Department of Pediatric and Congenital Cardiac Surgery and Cardiology, Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona “Umberto I, G. M. Lancisi, G. Salesi”, 60123 Ancona, Italy;
| | - Pierluigi Festa
- Pediatric Cardiology and GUCH Unit, Fondazione “G. Monasterio” CNR-Regione Toscana, 541200 Massa, Italy; (C.M.); (N.M.); (P.F.)
| |
Collapse
|
4
|
Meloni A, Nobile M, Keilberg P, Positano V, Santarelli MF, Pistoia L, Spasiano A, Casini T, Putti MC, Cuccia L, Bitti PP, Messina G, Peritore G, Renne S, Grassedonio E, Quaia E, Cademartiri F, Pepe A. Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major. Eur Radiol 2023; 33:7215-7225. [PMID: 37115218 PMCID: PMC10511559 DOI: 10.1007/s00330-023-09630-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/18/2023] [Accepted: 02/23/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVES This multicenter study assessed the extent of pancreatic fatty replacement and its correlation with demographics, iron overload, glucose metabolism, and cardiac complications in a cohort of well-treated patients with thalassemia major (TM). METHODS We considered 308 TM patients (median age: 39.79 years; 182 females) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Magnetic resonance imaging was used to quantify iron overload (IO) and pancreatic fat fraction (FF) by T2* technique, cardiac function by cine images, and to detect replacement myocardial fibrosis by late gadolinium enhancement technique. The glucose metabolism was assessed by the oral glucose tolerance test. RESULTS Pancreatic FF was associated with age, body mass index, and history of hepatitis C virus infection. Patients with normal glucose metabolism showed a significantly lower pancreatic FF than patients with impaired fasting glucose (p = 0.030), impaired glucose tolerance (p < 0.0001), and diabetes (p < 0.0001). A normal pancreatic FF (< 6.6%) showed a negative predictive value of 100% for abnormal glucose metabolism. A pancreatic FF > 15.33% predicted the presence of abnormal glucose metabolism. Pancreas FF was inversely correlated with global pancreas and heart T2* values. A normal pancreatic FF showed a negative predictive value of 100% for cardiac iron. Pancreatic FF was significantly higher in patients with myocardial fibrosis (p = 0.002). All patients with cardiac complications had fatty replacement, and they showed a significantly higher pancreatic FF than complications-free patients (p = 0.002). CONCLUSION Pancreatic FF is a risk marker not only for alterations of glucose metabolism, but also for cardiac iron and complications, further supporting the close link between pancreatic and cardiac disease. KEY POINTS • In thalassemia major, pancreatic fatty replacement by MRI is a frequent clinical entity, predicted by a pancreas T2* < 20.81 ms and associated with a higher risk of alterations in glucose metabolism. • In thalassemia major, pancreatic fatty replacement is a strong risk marker for cardiac iron, replacement fibrosis, and complications, highlighting a deep connection between pancreatic and cardiac impairment.
Collapse
Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U. O. C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Mario Nobile
- Sezione Di Scienze Radiologiche - Dipartimento Di Biopatologia E Biotecnologie Mediche, Policlinico "Paolo Giaccone", Palermo, Italy
| | - Petra Keilberg
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U. O. C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera Di Rilievo Nazionale "A. Cardarelli", Napoli, Italy
| | - Tommaso Casini
- Centro Talassemie Ed Emoglobinopatie, Ospedale "Meyer", Florence, Italy
| | - Maria Caterina Putti
- Dipartimento Della Salute Della Donna E del Bambino, Clinica Di Emato-Oncologia Pediatrica, Azienda Ospedaliero-Università Di Padova, Padua, Italy
| | - Liana Cuccia
- Unità Operativa Complessa Ematologia Con Talassemia, ARNAS Civico "Benfratelli-Di Cristina", Palermo, Italy
| | - Pier Paolo Bitti
- Dipartimento Dei Servizi, Servizio Immunoematologia E Medicina Trasfusionale, Presidio Ospedaliero "San Francesco" ASL Nuoro, Nuoro, Italy
| | - Giuseppe Messina
- Centro Microcitemie, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa Di Radiologia, ARNAS Civico "Benfratelli-Di Cristina", Palermo, Italy
| | - Stefania Renne
- Struttura Complessa Di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | - Emanuele Grassedonio
- Sezione Di Scienze Radiologiche - Dipartimento Di Biopatologia E Biotecnologie Mediche, Policlinico "Paolo Giaccone", Palermo, Italy
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, University of Padua, Giustiniani, 2 Street, 35128, Padova, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Giustiniani, 2 Street, 35128, Padova, Italy.
| |
Collapse
|
5
|
Meloni A, Pistoia L, Ricchi P, Positano V, Longo F, Borsellino Z, Cecinati V, Messina G, Corigliano E, Rosso R, Righi R, Peritore G, Renne S, Vallone A, Cademartiri F. Pancreatic T2* Magnetic Resonance Imaging for Prediction of Cardiac Arrhythmias in Transfusion-Dependent Thalassemia. J Clin Med 2023; 12:6015. [PMID: 37762955 PMCID: PMC10531669 DOI: 10.3390/jcm12186015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 09/29/2023] Open
Abstract
We assessed the value of pancreatic T2* magnetic resonance imaging (MRI) for predicting cardiac events from a large prospective database of transfusion-dependent thalassemia (TDT) patients. We considered 813 TDT patients (36.47 ± 10.71 years, 54.6% females) enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. MRI was used to measure hepatic, pancreatic, and cardiac iron overload (IO), to assess biventricular function and atrial dimensions, and to detect replacement myocardial fibrosis. The mean follow-up was 50.51 ± 19.75 months. Cardiac complications were recorded in 21 (2.6%) patients: one with heart failure (HF) and 20 with arrhythmias. The single patient who developed HF had, at the baseline MRI, a reduced pancreas T2*. Out of the 20 recorded arrhythmias, 17 were supraventricular. Pancreatic T2* values were a significant predictor of future arrhythmia-related events (hazard ratio = 0.89; p = 0.015). Pancreas T2* remained significantly associated with future arrhythmias after adjusting for any other univariate predictor (age and male sex, diabetes, history of previous arrhythmias, or left atrial area index). According to the receiver-operating characteristic curve analysis for arrhythmias, a pancreas T2* < 6.73 ms was the optimal cut-off value. In TDT, pancreatic iron levels had significant prognostic power for arrhythmias. Regular monitoring and the development of targeted interventions to manage pancreatic IO may help improve patient outcomes.
Collapse
Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.)
- Unità Operativa Complessa Bioingegneria, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.)
- Unità Operativa Semplice a Valenza Dipartimentale Ricerca Clinica, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Paolo Ricchi
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “Antonio Cardarelli”, 80131 Napoli, Italy;
| | - Vincenzo Positano
- Department of Radiology, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.)
- Unità Operativa Complessa Bioingegneria, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy
| | - Filomena Longo
- Unità Operativa Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria “S. Anna”, 44124 Cona, Italy;
| | - Zelia Borsellino
- Unità Operativa Complessa Ematologia con Talassemia, ARNAS Civico “Benfratelli-Di Cristina”, 90134 Palermo, Italy;
| | - Valerio Cecinati
- Struttura Semplice di Microcitemia, Ospedale “Santissima Annunziata”, 74123 Taranto, Italy;
| | - Giuseppe Messina
- Centro Microcitemie, Grande Ospedale Metropolitano “Bianchi-Melacrino-Morelli”, 89100 Reggio Calabria, Italy;
| | - Elisabetta Corigliano
- Ematologia Microcitemia, Ospedale San Giovanni di Dio—ASP Crotone, 88900 Crotone, Italy;
| | - Rosamaria Rosso
- Unità Operativa Talassemie ed Emoglobinopatie, Azienda Ospedaliero-Universitaria Policlinico “Vittorio Emanuele”, 95100 Catania, Italy;
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, 44023 Lagosanto, Italy;
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, ARNAS Civico “Benfratelli-Di Cristina”, 90127 Palermo, Italy;
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero “Giovanni Paolo II”, 88046 Lamezia Terme, Italy;
| | - Antonino Vallone
- Reparto di Radiologia, Azienda Ospedaliera “Garibaldi” Presidio Ospedaliero Nesima, 95126 Catania, Italy;
| | - Filippo Cademartiri
- Department of Radiology, Fondazione Gabriele Monasterio CNR-Regione Toscana, 56124 Pisa, Italy; (A.M.); (L.P.); (V.P.)
| |
Collapse
|
6
|
Pistoia L, Meloni A, Allò M, Spasiano A, Messina G, Sorrentino F, Gamberini MR, Ermini A, Renne S, Fina P, Peritore G, Positano V, Pepe A, Cademartiri F. Relationship between pancreatic iron overload, glucose metabolism and cardiac complications in sickle cell disease: An Italian multicentre study. Eur J Haematol 2022; 109:289-297. [PMID: 35690882 DOI: 10.1111/ejh.13809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Evidence about the cross-talk between iron, glucose metabolism, and cardiac disease is increasing. We aimed to explore the link of pancreatic iron by Magnetic Resonance Imaging (MRI) with glucose metabolism and cardiac complications (CC) in sickle cell disease (SCD) patients. METHODS We considered 70 SCD patients consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Iron overload was quantified by R2* technique and biventricular function by cine images. Macroscopic myocardial fibrosis was evaluated by late gadolinium enhancement technique. Glucose metabolism was assessed by the oral glucose tolerance test. RESULTS Patients with an altered glucose metabolism showed a significantly higher pancreas R2* than patients with normal glucose metabolism. Pancreatic siderosis emerged as a risk factor for the development of metabolic alterations (OddsRatio 8.25, 95%confidence intervals 1.51-45.1; p = .015). Global pancreas R2* values were directly correlated with mean serum ferritin levels and liver iron concentration. Global pancreas R2* was not significantly associated with global heart R2* and macroscopic myocardial fibrosis. Patients with history of CC showed a significantly higher global pancreas R2* than patients with no CC. CONCLUSIONS Our findings support the evaluation of pancreatic R2* by MRI in SCD patients to prevent the development of metabolic and cardiac disorders.
Collapse
Affiliation(s)
- Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Massimo Allò
- Ematologia Microcitemia, Ospedale San Giovanni di Dio - ASP Crotone, Crotone, Italy
| | - Anna Spasiano
- U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Giuseppe Messina
- Centro Microcitemie, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Francesco Sorrentino
- U.O.S. Day Hospital Talassemici, Ospedale "Sant'Eugenio"- ASL Roma2, Rome, Italy
| | - Maria Rita Gamberini
- U. O. di Day Hospital della Talassemia e delle Emoglobinopatie. Dipartimento della Riproduzione e dell'Accrescimento, Azienda Ospedaliero-Universitaria "S. Anna", Ferrara, Italy
| | - Angela Ermini
- S.O.S. Immunoematologia e Medicina Trasfusionale Ospedale S. Maria Annunziata, Florence, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | - Priscilla Fina
- Unità Operativa Complessa Diagnostica per Immagini, Ospedale "Sandro Pertini", Rome, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, "ARNAS" Civico, Di Cristina Benfratelli, Palermo, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Alessia Pepe
- Department of Medicine, Institute of Radiology, University of Padua, Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| |
Collapse
|
7
|
Meloni A, Barbuto L, Pistoia L, Positano V, Renne S, Peritore G, Fina P, Spasiano A, Allò M, Messina G, Casini T, Massa A, Romano L, Pepe A, Cademartiri F. Frequency, pattern, and associations of renal iron accumulation in sickle/β-thalassemia patients. Ann Hematol 2022; 101:1941-1950. [PMID: 35821343 DOI: 10.1007/s00277-022-04915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 07/04/2022] [Indexed: 11/29/2022]
Abstract
We evaluated frequency, pattern, and associations of renal iron accumulation in sickle/β-thalassemia. Thirty-three sickle/β-thalassemia patients (36.5 ± 14.7 years; 13 females), 14 homozygous sickle cell disease (SCD) patients, and 71 thalassemia major (TM) patients, enrolled in the E-MIOT Network, underwent magnetic resonance imaging. Iron overload (IO) was quantified by the T2* technique. Sickle/β-thalassemia patients had a significantly lower frequency of renal IO (T2* < 31 ms) than homozygous SCD patients (9.1% vs. 57.1%; P = 0.001), besides having similar hepatic, cardiac and pancreatic IO. Kidney T2* values were comparable between regularly transfused sickle/β-thalassemia and TM patients but were significantly lower in regularly transfused homozygous SCD patients than in the other two groups. In sickle/β-thalassemia patients, global renal T2* values were not associated with age, gender, splenectomy, and presence of regular transfusions or chelation. No correlation was detected between renal T2* values and serum ferritin levels or iron load in the other organs. Global renal T2* values were not associated with serum creatinine levels but showed a significant inverse correlation with serum lactate dehydrogenase (R = - 0.709; P < 0.0001) and indirect bilirubin (R = - 0.462; P = 0.012). Renal IO is not common in sickle/β-thalassemia patients, with a prevalence significantly lower compared to that of homozygous SCD patients, but with a similar underlying mechanism due to the chronic hemolysis.
Collapse
Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy.,U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Luigi Barbuto
- U.O.C. Radiologia Generale E Di Pronto Soccorso, Azienda Ospedaliera Di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Laura Pistoia
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy
| | - Vincenzo Positano
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy.,U.O.C. Bioingegneria, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Stefania Renne
- Struttura Complessa Di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II", Lamezia Terme, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa Di Radiologia, "ARNAS" Civico, Di Cristina Benfratelli, Palermo, Italy
| | - Priscilla Fina
- Unità Operativa Complessa Diagnostica Per Immagini, Ospedale "Sandro Pertini", Rome, Italy
| | - Anna Spasiano
- U.O.S.D. Malattie Rare del Globulo Rosso, Azienda Ospedaliera Di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Massimo Allò
- Ematologia Microcitemia, Ospedale San Giovanni di Dio - ASP Crotone, Crotone, Italy
| | - Giuseppe Messina
- Centro Microcitemie, Grande Ospedale Metropolitano "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Tommaso Casini
- Centro Talassemie Ed Emoglobinopatie, Ospedale "Meyer", Florence, Italy
| | - Antonella Massa
- Servizio Trasfusionale, Ospedale "Giovanni Paolo II", Olbia, Italy
| | - Luigia Romano
- U.O.C. Radiologia Generale E Di Pronto Soccorso, Azienda Ospedaliera Di Rilievo Nazionale "A. Cardarelli", Naples, Italy
| | - Alessia Pepe
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1 - 56124, Pisa, Italy.
| |
Collapse
|
8
|
Pepe A, Pistoia L, Gamberini MR, Cuccia L, Peluso A, Messina G, Spasiano A, Allò M, Bisconte MG, Putti MC, Casini T, Dello Iacono N, Celli M, Vitucci A, Giuliano P, Peritore G, Renne S, Righi R, Positano V, De Sanctis V, Meloni A. The Close Link of Pancreatic Iron With Glucose Metabolism and With Cardiac Complications in Thalassemia Major: A Large, Multicenter Observational Study. Diabetes Care 2020; 43:2830-2839. [PMID: 32887708 DOI: 10.2337/dc20-0908] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/08/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We systematically explored the link of pancreatic iron with glucose metabolism and with cardiac complications in a cohort of 1,079 patients with thalassemia major (TM) enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. RESEARCH DESIGN AND METHODS MRI was used to quantify iron overload (T2* technique) and cardiac function (cine images) and to detect macroscopic myocardial fibrosis (late gadolinium enhancement technique). Glucose metabolism was assessed by the oral glucose tolerance test (OGTT). RESULTS Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with impaired fasting glucose, impaired glucose tolerance, and diabetes. A pancreas T2* <13.07 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for disturbances of glucose metabolism and for cardiac iron. Patients with myocardial fibrosis showed significantly lower pancreas T2* values. Patients with cardiac complications had significantly lower pancreas T2* values. No patient with arrhythmias/heart failure had a normal global pancreas T2*. CONCLUSIONS Pancreatic iron is a powerful predictor not only for glucose metabolism but also for cardiac iron and complications, supporting the close link between pancreatic iron and heart disease and the need to intensify iron chelation therapy to prevent both alterations of glucose metabolism and cardiac iron accumulation.
Collapse
Affiliation(s)
- Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Laura Pistoia
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Maria Rita Gamberini
- Dipartimento della Riproduzione e dell'Accrescimento, Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, Ferrara, Italy
| | - Liana Cuccia
- Unità Operativa Complessa Ematologia con Talassemia, Azienda di Rilievo Nazionale ed Alta Specializzazione Ospedali Civico Di Cristina Benfratelli, Palermo, Italy
| | - Angelo Peluso
- Struttura Semplice di Microcitemia, Ospedale "SS. Annunziata" ASL Taranto, Taranto, Italy
| | - Giuseppe Messina
- Centro Microcitemie, Azienda Ospedaliera "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy
| | - Anna Spasiano
- Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "Antonio Cardarelli," Napoli, Italy
| | - Massimo Allò
- Ematologia Microcitemia, Ospedale San Giovanni di Dio-Azienda Sanitaria Provinciale Crotone, Crotone, Italy
| | - Maria Grazia Bisconte
- Centro di Microcitemia, Unità Operativa Ematologia, Azienda Ospedaliera Cosenza, Cosenza, Italy
| | - Maria Caterina Putti
- Clinica di Emato-Oncologia Pediatrica, Dipartimento di Salute della Donna e del Bambino, Azienda Ospedaliero di Padova-Università di Padova, Padova, Italy
| | - Tommaso Casini
- Centro Talassemie ed Emoglobinopatie, Ospedale "Meyer," Firenze, Italy
| | - Nicola Dello Iacono
- Centro Microcitemia, Day Hospital Thalassemia, Poliambulatorio "Giovanni Paolo II," Ospedale Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy
| | - Mauro Celli
- Unità Operativa Complessa di ImmunoEmatologia, Dipartimenti Assistenziali Integrati di Pediatria e Neuropsiachiatria Infantile, Roma, Italy
| | - Angelantonio Vitucci
- Ematologia con Trapianto-Servizio Regionale Talassemie, Dipartimento dell'Emergenza e dei Trapianti d'Organo, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Bari, Italy
| | - Pietro Giuliano
- Cardiologia con UTIC, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy
| | - Giuseppe Peritore
- Unità Operativa Complessa di Radiologia, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy
| | - Stefania Renne
- Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II," Lamezia Terme, Italy
| | - Riccardo Righi
- Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, Italy
| | - Vincenzo Positano
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Vincenzo De Sanctis
- Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Antonella Meloni
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| |
Collapse
|
9
|
Meloni A, Pistoia L, Giunta N, Renne S, Missere M, Grassedonio E, Peritore G, Pulini S, Pasin M, Sanna PMG, Positano V, Pepe A. P5263Genotype and cardiac findings in non transfusion dependent thalassemia patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
In non transfusion dependent thalassemia (NTDT) the lack of a clear genotype-phenotype relationship complicates the already complex and extensive scenario in clinical practice.
Purpose
Our aim was to detect if the presence of a β°/β° homozygous genotype was associated to different rate of cardiac findings by Cardiovascular Magnetic Resonance (CMR) and cardiac complications.
Methods
We considered 81 patients with thalassemia intermedia never transfused o who received occasional transfusions (37.7±11.4 years, 39 females) consecutively enrolled in the Myocardial Iron Overload in Thalassemia project. CMR was used to quantify iron overload (T2* technique), biventricular morphological and functional parameters (cine sequences), and the presence of myocardial fibrosis (late gadolinium enhancement-LGE technique). All cardiac complications were classified according to international guidelines.
Results
Two groups of patients were identified: non homozygous β°/β° genotype (N=61) and homozygous β°/β° genotype (N=20.) No significant differences for sex and age were found between the groups.
Patients with homozygous β°/β° genotype had lower mean haemoglobin levels (8.6±1.1g/dl vs 9.2±1.2 g/dl) but the difference did not reach the statistical significance (P=0.060).
No patient showed cardiac iron and global heart T2* values were comparable between the two groups. Left atrial area index, left ventricular (LV) end-diastolic, end-systolic and stroke volume indexes, LV mass index, right ventricular end-diastolic and end-systolic volume indexes were significantly higher in the homozygous β°/β° group (see Table).
Frequencies of heart failure and arrhythmias were comparable between the groups.
Non-β0/β0 homozygous genotype β0/β0 homozygous genotype P Left Atrial Area (cm2/m2) 13.87±2.59 16.63±2.59 0.001 LV EDVI (ml/m2) 94.88±15.59 112.94±21.52 0.003 LV ESVI (ml/m2) 35.22±9.55 41.88±9.70 0.018 LV SVI (ml/m2) 61.98±12.57 69.81±11.20 0.029 LV mass index (g/m2) 61.26±10.15 68.63±15.89 0.030 RV EDVI (ml/m2) 91.27±23.50 107.53±23.87 0.019 RV ESVI (ml/m2) 33.93±17.55 40.81±15.20 0.043
Conclusions
Heart remodelling related to a high cardiac output state cardiomyopathy was more pronounced in patients with homozygous β°/β° genotype. These data can support the knowledge of different phenotypic groups in the management of NTDT patients.
Collapse
Affiliation(s)
- A Meloni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - L Pistoia
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | | | - S Renne
- Presidio Ospedaliero “Giovanni Paolo II”, Lamezia Terme, Italy
| | - M Missere
- Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche - “Giovanni Paolo II”, Campobasso, Italy
| | | | | | - S Pulini
- Ospedale Civile “Spirito Santo”, Pescara, Italy
| | - M Pasin
- Sandro Pertini Hospital, Rome, Italy
| | | | - V Positano
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Pepe
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
10
|
Pepe A, Meloni A, Salvadori S, Vallone A, Renne S, Peritore G, Preziosi P, Riva A, Missere M, Bitti PP, Spadola V, Positano V, Pistoia L. 524Genotypic groups as risk factor for cardiac MR abnormalities and complications in thalassemia major. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A Pepe
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - A Meloni
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - S Salvadori
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | | | - S Renne
- P.O.Giovanni Paolo II, Lamezia Terme, Italy
| | | | | | - A Riva
- OSP. SS. Annunziata ASL Taranto, Taranto, Italy
| | - M Missere
- Centro di Ricerca e Formazione ad Alta Tecnologia nelle Scienze Biomediche - "Giovanni Paolo II", Campobasso, Italy
| | - P P Bitti
- San Francesco Hospital, Nuoro, Italy
| | - V Spadola
- Azienda Ospedaliera Civile - O.M.P.A. Ragusa, Ragusa, Italy
| | - V Positano
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - L Pistoia
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| |
Collapse
|
11
|
Ait Ali L, Aquaro GD, Peritore G, Ricci F, De Marchi D, Emdin M, Passino C, Festa P. Cardiac Magnetic Resonance Evaluation of Pulmonary Transit Time and Blood Volume in Adult Congenital Heart disease. J Magn Reson Imaging 2019; 50:779-786. [DOI: 10.1002/jmri.26684] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/06/2022] Open
Affiliation(s)
- Lamia Ait Ali
- Institute of Clinical Physiology CNR; Massa Italy
- MRI Lab, Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
| | | | | | - Fabrizio Ricci
- Institute for Advanced Biomedical Technologies, Department of Neuroscience, Imaging and Clinical Sciences; "G. d'Annunzio" University; Chieti Italy
| | | | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine; Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
| | - Claudio Passino
- Division of Cardiology and Cardiovascular Medicine; Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
| | - Pierluigi Festa
- MRI Lab, Fondazione G. Monasterio CNR-Regione Toscana; Pisa Italy
- Pediatric Cardiology and GUCH Unit; Fondazione G. Monasterio CNR-Regione Toscana; Massa Italy
| |
Collapse
|
12
|
Pepe A, Pistoia L, Giunta N, Fotzi I, Benni M, Barone A, Macchi S, Pasin F, Peritore G, Fina P, Positano V, Meloni A. P1608Chronic hepatitis C virus infection in thalassemia major: a new cardiovascular risk factor? Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Pepe
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - L Pistoia
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | | | - I Fotzi
- Ospedale “Meyer”, Firenze, Italy
| | - M Benni
- Policlinico S. Orsola “L. e A. Seragnoli”, Bologna, Italy
| | - A Barone
- University Hospital of Parma, Parma, Italy
| | - S Macchi
- Santa Maria delle Croci Hospital, Ravenna, Italy
| | - F Pasin
- Ospedale S. Pertini, Roma, Italy
| | | | - P Fina
- Ospedale S. Pertini, Roma, Italy
| | - V Positano
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - A Meloni
- Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| |
Collapse
|
13
|
Giuliano P, Meloni A, Pistoia L, Giunta N, Peritore G, Caccamo G, Salli A, Miciotto F, Cuccia L, Campisi S, Paci C, Renni R, Pepe A. P3329Long term prospective predictors for vascular events and cardiac complications in thalassemia major patients. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
14
|
Abstract
In the human lower limb, the magnitudes of both Hoffmann (H) reflexes and primary somatosensory evoked potentials (SEPs) from scalp electrodes, are reduced by active and/or passive movement. We surmised that similar effects occur for the upper limb and specifically hypothesised that amplitudes of median nerve induced flexor carpii radialis H reflexes and cortical SEPs are reduced with passive movement about the wrist or elbow. The results showed (P<0. 05) that either movement significantly attenuated mean magnitudes of SEPs elicited from stimulation at elbow or wrist and that reflex magnitudes attenuated with wrist movement. Thus, the upper limb shows similar movement-induced modulation to the lower limb. These attenuations of fast conducting sensory paths consequent to movement per se, may be a basic level of motor control, initiated from muscle mechanoreceptor discharge. Upon this basic level, more complex modulations then may be laid as appropriate for the particular characteristics of active motor tasks.
Collapse
Affiliation(s)
- J D Brooke
- Human Neurophysiology Laboratory, Department of Human Biology and Nutritional Sciences, University of Guelph, Ontario, Guelph, Canada.
| | | | | | | | | |
Collapse
|
15
|
Brooke JD, McIlroy WE, Miklic M, Staines WR, Misiaszek JE, Peritore G, Angerilli P. Modulation of H reflexes in human tibialis anterior muscle with passive movement. Brain Res 1997; 766:236-9. [PMID: 9359607 DOI: 10.1016/s0006-8993(97)00625-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Significant movement-induced gain changes in H reflexes have been observed in soleus muscle following passive movement of the lower limb. Hypotheses from these concepts were tested on magnitudes of H reflexes in tonically contracted tibialis anterior. From eleven subjects at rates of 20 and 60 r.p.m. passive leg movement, statistically significant attenuation from controls and phasic modulation occurred. The results make more general the conclusions from soleus H reflexes. However, the functional effect should be much smaller, as tibialis anterior H reflexes are smaller compared to those in soleus.
Collapse
Affiliation(s)
- J D Brooke
- Department of Human Biology and Nutritional Sciences, University of Guelph, Ont., Canada
| | | | | | | | | | | | | |
Collapse
|