Correlation of Serum Ferritin Level with Heart T2 MRI in Transfusion Dependent Thalassemia: a Systematic Review and Meta-Analysis.

BACKGROUND

Cardiac complications in patients with transfusion-dependent thalassemia (TDT) are one of the major causes of mortality in these patients which annually impose economic burden on the endemic countries. Heart T2 MRI is a good modality for evaluating iron overload. Our aim was to investigate the pooled correlation between the serum ferritin level and heart iron overload in TDT patients and compare the effect size in different geographical areas.

METHODS

PRISMA checklist was used to summarize the literature search. Three major databases were used for the papers and exported into endnote for screening. Data were extracted into an Excel spreadsheet. The data were analyzed using STATA software. CC was considered as the effect size, and the amount of heterogeneity was indicated by I-squared. Meta-regression was used for age. Also, sensitivity analysis was performed.

RESULTS

The present study showed a statistically significant negative correlation of the serum ferritin level with heart T2 MRI: -0.30 (95% CI -0.34, -25). This correlation was not significantly affected by the patients' age (p-value: 0.874). Given different geographic area, most of the studies from different countries indicated that the correlation between the serum ferritin and heart T2 MRI was statistically significant.

CONCLUSIONS

The pooled analysis showed a significant negative moderate correlation between the serum ferritin level and heart T2 MRI in patients with TDT, regardless of their age. This issue underscores the importance of periodical evaluation of serum ferritin level in patients with TDT in developing countries with low financial supports and limited resources. Further studies are suggested to evaluate the pooled correlation of the serum ferritin level with iron concentration of other vital organs.