Early Detection of Myocardial Iron Overload in Patients with β-Thalassaemia Major Using Cardiac Magnetic Resonance T1 Mapping

Abstract

Abstract Introduction Iron-induced cardiomyopathy is a leading cause of death in patients with β-thalassemia major. Chelation therapy is effective in removing cardiac iron and improving survival rates. However, early diagnosis is often delayed. The T2* technique, which is used for quantifying myocardial iron overload, has limitations in detecting early iron overload. In vivo mapping of the myocardial T1 relaxation time is a promising alternative that could improve early detection and management of iron-induced cardiomyopathy. Methods 32 β-thalassemia major patients were enrolled in our study with mean age 11.5 ± 4 years. Measurement of the mid-level septal iron overload was done through T1 mapping using modified Look-Locker inversion recovery sequence with a 3 (3 s) 3 (3 s) 5 scheme. Septum was divided at the mentioned level into 3 zones namely zone 1, zone 2 and zone 3 which correspond to segments 8 & 9 in cardiac segmentation model. Results The T1 technique was able to detect 4 patients with myocardial iron overload, two of which were detected by the T2* technique. There was a statistically significant correlation between the average T1 values of the studied zones in patients with β-TM and the LIC, the T1 Values within segment 8 of the liver, age of patients, transfusion onset age, age of splenectomy and serum ferritin value. Conclusion The addition of the T1 Mapping sequence to the conventionally used T2* technique was able to increase the efficacy of the Myocardial iron overload detection protocol by earlier detection of Myocardial iron overload. This would guide chelation therapy to decrease myocardial morbidity.