27) Different patterns of myocardial iron distribution by whole-heart T2* Magnetic Resonance as risk markers for heart complications in thalassemia major.

Background: The multislice multiecho T2* cardiovascular magnetic resonance (CMR) technique allows to detect different patterns of myocardial iron overload (MIO). The aim of this cross-sectional study was to verify the association between cardiac complications (heart failure and arrhythmias), biventricular dysfunction and myocardial fibrosis with different patterns of MIO in thalassemia major (TM) patients. Methods: We considered 812 TM patients enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) Network. The T2* value in all the 16 cardiac segments was evaluated. Results:We identified 4 groups of patients: 138with homogeneous MIO (all segments with T2* b 20 ms), 97with heterogeneousMIO (some segments with T2* b 20 ms, others with T2* ≥20 ms) and significant global heart iron (global heart T2* b 20 ms), 238 with heterogeneous MIO and no significant global heart iron, and 339 with no MIO (all segments with T2* ≥ 20 ms). Compared to patients with no MIO, patients with homogeneous MIO were more likely to have cardiac complications (odds ratio—OR = 2.67), heart failure (OR = 2.54), LV dysfunction (OR = 5.59), and RV dysfunction (OR = 2.26); patients with heterogeneous MIO and significant global heart iron were more likely to have heart failure (OR = 2.38) and LV dysfunction (OR = 2.39). Conclusions: Cardiac complications, heart failure and dysfunction were correlated with MIO distribution with an increasing risk from the TM patientswith no MIO to thosewith homogeneousMIO. Using a segmental approach, early iron deposit or homogeneous MIO patterns can be characterized to better tailor chelation therapy.