Institute of Cardiovascular Science, University College London, London, UK.
Barts Heart Centre, Saint Bartholomew's Hospital, London, UK.
Eur Heart J Qual Care Clin Outcomes. 2022 May 5;8(3):289-297. doi: 10.1093/ehjqcco/qcab089.
To explore the impact of incorporating a faster cardiac magnetic resonance (CMR) imaging protocol in a low-middle-income country (LMIC) and using the result to guide chelation in transfusion-dependent patients.
A prospective UK-India collaborative cohort study was conducted in two cities in India. Two visits 13 months apart included clinical assessment and chelation therapy recommendations based on rapid CMR results. Participants were recruited by the local patient advocate charity, who organized the patient medical camps. The average scanning time was 11.3 ± 2.5 min at the baseline and 9.8 ± 2.4 min (P < 0.001) at follow-up. The baseline visit was attended by 103 patients (mean age 25 years) and 83% attended the second assessment. At baseline, 29% had a cardiac T2* < 20 ms, which represents significant iron loading, and 12% had left ventricular ejection fraction <60%, the accepted lower limit in this population. Only 3% were free of liver iron (T2* ≥ 17 ms). At 13 months, more patients were taking intensified dual chelation therapy (43% vs. 55%, P = 0.002). In those with cardiac siderosis (baseline T2* < 20 ms), there was an improvement in T2*-10.9 ± 5.9 to 13.5 ± 8.7 ms, P = 0.005-and fewer were classified as having clinically important cardiac iron loading (T2* < 20 ms, 24% vs. 16%, P < 0.001). This is the first illustration in an LMIC that incorporating CMR results into patient management plans can improve cardiac iron loading.
For thalassaemia patients in an LMIC, a simplified CMR protocol linked to therapeutic recommendation via the patient camp model led to enhanced chelation therapy and a reduction in cardiac iron in 1 year.
探索在中低收入国家（LMIC）中纳入更快的心脏磁共振（CMR）成像方案的影响，并利用结果指导依赖输血的患者的螯合治疗。
在印度的两个城市进行了一项前瞻性的英印合作队列研究。两次访问相隔 13 个月，包括根据快速 CMR 结果进行临床评估和螯合治疗建议。参与者由当地的患者权益慈善机构招募，该慈善机构组织了患者医疗营。平均扫描时间在基线时为 11.3±2.5 分钟，随访时为 9.8±2.4 分钟（P<0.001）。基线访问时，有 103 名患者（平均年龄 25 岁）参加，83%的患者参加了第二次评估。基线时，29%的患者心脏 T2*<20ms，代表严重的铁负荷，12%的患者左心室射血分数<60%，这是该人群的接受下限。只有 3%的患者无肝脏铁（T2*>17ms）。在 13 个月时，更多的患者接受了强化双重螯合治疗（43%比 55%，P=0.002）。在有心脏铁沉积的患者中（基线 T2*<20ms），T2*-10.9±5.9 改善至 13.5±8.7ms，P=0.005，且更少的患者被归类为有临床意义的心脏铁负荷（T2*<20ms，24%比 16%，P<0.001）。这是在 LMIC 中首次证明将 CMR 结果纳入患者管理计划可以改善心脏铁负荷。
对于 LMIC 的地中海贫血患者，简化的 CMR 方案通过患者营地模式与治疗建议相关联，导致螯合治疗增强，并在 1 年内减少心脏铁。
