Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major.
Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major.
复制标题
心脏T2*磁共振用于预测Thalassexia Pajor的心脏并发症。
DOI：
10.1161/circulationaha.109.874487
复制
发表时间：
2009-11-17
期刊：
影响因子：
37.8
通讯作者：
Pennell DJ
中科院分区：
文献类型：
--
作者：
Kirk P;Roughton M;Porter JB;Walker JM;Tanner MA;Patel J;Wu D;Taylor J;Westwood MA;Anderson LJ;Pennell DJ
目的探讨心脏T2*磁共振（MR）对重度地中海贫血心衰和心律失常的预测价值。我们分析了来自21个英国中心的652名地中海贫血主要患者的心脏和肝脏T2* MR和血清铁蛋白，进行了1442次MR扫描。心脏T2*值<10ms（与bbb10 10ms相比）心力衰竭的相对危险度（95% CI）为160（39,653）。47%的患者在心脏T2* <6ms的一年内发生心力衰竭，相对风险为270（64,1129）。预测心力衰竭的ROC曲线下面积，心脏T2*(0.948)明显大于肝脏T2* （0.589， P<0.001）或血清铁蛋白（0.629，P<0.001）。心衰患者的心脏T2*在98%的扫描中<10ms。T2*值<20ms时发生心律失常的相对危险度为4.6（与>20ms相比）（2.66,7.95）。14%的患者在心脏T2* <6ms的一年内发生心律失常。预测心律失常的ROC曲线下面积心脏T2*(0.747)明显大于肝脏T2* （0.514， P<0.001）或血清铁蛋白（0.518，P<0.001）。在发生心律失常的患者中，83%的扫描结果显示心脏T2* <20ms。心脏T2* MR可识别重度地中海贫血患者心肌铁沉着引起的心力衰竭和心律失常高危患者，优于血清铁蛋白和肝铁。使用心脏T2*对有风险的患者进行早期识别和治疗，是降低心肌铁沉着患者心脏死亡率高负担的合理手段。
To determine the predictive value of cardiac T2* magnetic resonance (MR) for heart failure and arrhythmia in thalassemia major. We analyzed cardiac and liver T2* MR, and serum ferritin on 652 thalassemia major patients from 21 UK centers, with 1,442 MR scans. The relative risk (95% CI) for heart failure with cardiac T2* values <10ms (compared with >10ms) was 160 (39, 653). Heart failure occurred in 47% of patients within one year of a cardiac T2* <6ms with relative risk 270 (64, 1129). The area under the ROC curve for predicting heart failure was significantly greater for cardiac T2* (0.948) than for liver T2* (0.589, P<0.001) or serum ferritin (0.629, P<0.001). Cardiac T2* was <10ms in 98% of scans in patients who developed heart failure. The relative risk for arrhythmia with cardiac T2* values <20ms (compared with >20ms), was 4.6 (2.66, 7.95). Arrhythmia occurred in 14% of patients within one year of a cardiac T2* of <6ms. The area under the ROC curve for predicting arrhythmia was significantly greater for cardiac T2* (0.747) than for liver T2* (0.514, P<0.001) or serum ferritin (0.518, P<0.001). The cardiac T2* was <20ms in 83% of scans in patients who developed arrhythmia. Cardiac T2* MR identifies patients at high risk of heart failure and arrhythmia from myocardial siderosis in thalassemia major, and is superior to serum ferritin and liver iron. Using cardiac T2* for the early identification and treatment of patients at risk is a logical means towards reducing the high burden of cardiac mortality in myocardial siderosis.