On T2*Magnetic Resonance and Cardiac Iron

被引：386

作者：

Carpenter, John-Paul ^{[1
,2
]}

He, Taigang ^{[1
,2
]}

Kirk, Paul ^{[1
,2
]}

Roughton, Michael ^{[4
]}

Anderson, Lisa J. ^{[3
]}

de Noronha, Sofia V. ^{[1
]}

Sheppard, Mary N. ^{[1
]}

Porter, John B. ^{[4
]}

Walker, J. Malcolm ^{[4
]}

Wood, John C. ^{[5
]}

Galanello, Renzo ^{[6
]}

Forni, Gianluca ^{[7
]}

Catani, Gualtiero ^{[8
]}

Matta, Gildo ^{[8
]}

Fucharoen, Suthat ^{[9
]}

Fleming, Adam ^{[10
]}

House, Michael J. ^{[10
]}

Black, Greg ^{[10
]}

Firmin, David N. ^{[1
,2
]}

St Pierre, Timothy G. ^{[10
]}

Pennell, Dudley J. ^{[1
,2
]}

机构：

[1] Royal Brompton & Harefield Natl Hlth Serv Fdn Tru, London, England

[2] Univ London Imperial Coll Sci Technol & Med, Natl Heart & Lung Inst, London, England

[3] St Georges Hosp Natl Hlth Serv Trust, London, England

[4] Univ Coll Hosp Natl Hlth Serv Trust, London, England

[5] Childrens Hosp Los Angeles, Los Angeles, CA USA

[6] Univ Cagliari, Osped Reg Microcitemie, Cagliari, Italy

[7] Osped Galliera Genova, Genoa, Italy

[8] Azienda Osped Brotzu, Cagliari, Italy

[9] Mahidol Univ, Puttamonthon Nakornpatho, Thailand

[10] Univ Western Australia, Perth, WA 6009, Australia

来源：

CIRCULATION | 2011年 / 123卷 / 14期

基金：

美国国家卫生研究院; 澳大利亚研究理事会;

关键词：

heart; iron overload; magnetic resonance imaging; siderosis; thalassemia; T2-ASTERISK-CARDIOVASCULAR MAGNETIC-RESONANCE; MYOCARDIAL IRON; THALASSEMIA MAJOR; CONDUCTION SYSTEM; TISSUE IRON; OVERLOAD; SURVIVAL; HEART; HEMOCHROMATOSIS; COMPLICATIONS;

D O I：

10.1161/CIRCULATIONAHA.110.007641

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background-Measurement of myocardial iron is key to the clinical management of patients at risk of siderotic cardiomyopathy. The cardiovascular magnetic resonance relaxation parameter R2* (assessed clinically via its reciprocal, T2*) measured in the ventricular septum is used to assess cardiac iron, but iron calibration and distribution data in humans are limited. Methods and Results-Twelve human hearts were studied from transfusion-dependent patients after either death (heart failure, n = 7; stroke, n = 1) or transplantation for end-stage heart failure (n = 4). After cardiovascular magnetic resonance R2* measurement, tissue iron concentration was measured in multiple samples of each heart with inductively coupled plasma atomic emission spectroscopy. Iron distribution throughout the heart showed no systematic variation between segments, but epicardial iron concentration was higher than in the endocardium. The mean+/-SD global myocardial iron causing severe heart failure in 10 patients was 5.98 +/- 2.42 mg/g dry weight (range, 3.19 to 9.50 mg/g), but in 1 outlier case of heart failure was 25.9 mg/g dry weight. Myocardial ln[R2*] was strongly linearly correlated with ln[ Fe] (R-2 = 0.910, P < 0.001), leading to [Fe] = 45.0 x (T2*)(-1.22) for the clinical calibration equation with [ Fe] in milligrams per gram dry weight and T2* in milliseconds. Midventricular septal iron concentration and R2* were both highly representative of mean global myocardial iron. Conclusions-These data detail the iron distribution throughout the heart in iron overload and provide calibration in humans for cardiovascular magnetic resonance R2* against myocardial iron concentration. The iron values are of considerable interest in terms of the level of cardiac iron associated with iron-related death and indicate that the heart is more sensitive to iron loading than the liver. The results also validate the current clinical practice of monitoring cardiac iron in vivo by cardiovascular magnetic resonance of the midseptum. (Circulation. 2011;123:1519-1528.)

引用

页码：1519 / 1528

页数：10

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