Meloni Antonella, Pistoia Laura, Ricchi Paolo, Maggio Aurelio, Cecinati Valerio, Longo Filomena, Sorrentino Francesco, Borsellino Zelia, Salvo Alessandra, Rossi Vincenza, Grassedonio Emanuele, Restaino Gennaro, Renne Stefania, Righi Riccardo, Positano Vincenzo, Cademartiri Filippo
Bioengineering Unit, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy.
Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy.
J Clin Med. 2024 Feb 23;13(5):1281. doi: 10.3390/jcm13051281.
We prospectively evaluated the predictive value of multiparametric cardiac magnetic resonance (CMR) for cardiovascular complications in non-transfusion-dependent β-thalassemia (β-NTDT) patients who started regular transfusions in late childhood/adulthood (neo β-TDT).
We considered 180 patients (38.25 ± 11.24 years; 106 females). CMR was used to quantify cardiac iron overload, biventricular function, and atrial dimensions, and to detect left ventricular (LV) replacement fibrosis.
During a mean follow-up of 76.87 ± 41.60 months, 18 (10.0%) cardiovascular events were recorded: 2 heart failures, 13 arrhythmias (10 supraventricular), and 3 cases of pulmonary hypertension. Right ventricular (RV) end-diastolic volume index (EDVI), RV mass index (MI), LV replacement fibrosis, and right atrial (RA) area index emerged as significant univariate prognosticators of cardiovascular complications. The low number of events prevented us from performing a multivariable analysis including all univariable predictors simultaneously. Firstly, a multivariable analysis including the two RV size parameters (mass and volume) was carried out, and only the RV MI was proven to independently predict cardiovascular diseases. Then, a multivariable analysis, including RV MI, RA atrial area, and LV replacement fibrosis, was conducted. In this model, RV MI and LV replacement fibrosis emerged as independent predictors of cardiovascular outcomes (RV MI: hazard ratio (HR) = 1.18; LV replacement fibrosis: HR = 6.26).
Our results highlight the importance of CMR in cardiovascular risk stratification.
我们前瞻性评估了多参数心脏磁共振成像（CMR）对在儿童晚期/成年期开始定期输血的非输血依赖型β地中海贫血（β-NTDT）患者（新β-TDT）心血管并发症的预测价值。
我们纳入了180例患者（年龄38.25±11.24岁；女性106例）。使用CMR量化心脏铁过载、双心室功能和心房大小，并检测左心室（LV）替代纤维化。
在平均76.87±41.60个月的随访期间，记录到18例（10.0%）心血管事件：2例心力衰竭、13例心律失常（10例室上性）和3例肺动脉高压。右心室（RV）舒张末期容积指数（EDVI）、RV质量指数（MI）、LV替代纤维化和右心房（RA）面积指数是心血管并发症的重要单因素预后指标。事件数量较少，使我们无法同时对所有单因素预测指标进行多变量分析。首先，进行了一项包括两个RV大小参数（质量和容积）的多变量分析，结果显示只有RV MI可独立预测心血管疾病。然后，进行了一项包括RV MI、RA心房面积和LV替代纤维化的多变量分析。在该模型中，RV MI和LV替代纤维化是心血管结局的独立预测指标（RV MI：风险比（HR）=1.18；LV替代纤维化：HR = 6.26）。
我们的结果突出了CMR在心血管风险分层中的重要性。
