Investigating the Relationship Between Liver and Heart Iron Overload Measured by T2 ⃰ Magnetic Resonance Imaging with Serum Ferritin Level, Liver Enzyme Ratio (Aspartate Aminotransferase / Alanine Aminotransferase) and Electrocardiography Findings in Patients with Thalassemia Major
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Date
2024-04-30
0000-0003-2508-3212 Journal Title
Journal ISSN
Volume Title
Publisher
Brieflands
Abstract
Background: Cardiomyopathy caused by iron overload remains the leading cause of death in beta-thalassemia major patients. Objectives: The aim of this study is to investigate the relationship between serum ferritin levels, the liver enzyme ratio [aspartate aminotransferase/alanine aminotransferase (AST/ALT)], and electrocardiography (ECG) findings with the amount of iron deposition in the liver and heart of thalassemia major patients, as measured by R2* magnetic resonance imaging (R2* MRI) and T2* MRI. The main approach and innovation of this study is to examine the ECG findings of patients with dominant thalassemia and evaluate them alongside advanced MRI and laboratory data, which have not been comprehensively analyzed before. Methods: A total of 108 thalassemia major patients who received blood transfusions for one consecutive year were included in this retrospective study. Data regarding R2* MRI and T2* MRI of the heart and liver, echocardiography, serum ferritin levels, and liver enzyme measurements were collected from patient records. The relationship between T2* MRI findings and other parameters was analyzed. Heart and liver T2* were classified into normal, mild, moderate, severe, and very severe iron overload categories. Results: Severe iron overload was observed in 22.2% of patients in the heart and 65.7% in the liver. Pearson's correlation coefficient did not indicate a significant relationship between serum ferritin levels and echocardiography findings across different patient groups (P > 0.05). However, when analyzing the relationship between ferritin levels and iron deposition in the liver and heart, regardless of the classification of iron overload levels, a significant inverse linear correlation was found between serum ferritin levels and liver MRI T2* (P < 0.001). Additionally, a statistically significant direct correlation was observed between ferritin levels and liver MRI R2* (P < 0.001). Conclusions: For a more accurate assessment of hemosiderosis in thalassemia patients, it is recommended to evaluate iron deposition in the liver and heart using MRI R2* and T2*. The complications of this disease are associated with underlying causes and risk factors, emphasizing the importance of timely diagnosis and prevention.