Alessia Pepe1, Laura Pistoia2, Maria Rita Gamberini3, Liana Cuccia4, Angelo Peluso5, Giuseppe Messina6, Anna Spasiano7, Massimo Allò8, Maria Grazia Bisconte9, Maria Caterina Putti10, Tommaso Casini11, Nicola Dello Iacono12, Mauro Celli13, Angelantonio Vitucci14, Pietro Giuliano15, Giuseppe Peritore16, Stefania Renne17, Riccardo Righi18, Vincenzo Positano2, Vincenzo De Sanctis19, Antonella Meloni2. 1. Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy alessia.pepe@ftgm.it. 2. Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy. 3. Dipartimento della Riproduzione e dell'Accrescimento, Day Hospital della Talassemia e delle Emoglobinopatie, Azienda Ospedaliero-Universitaria di Ferrara - Arcispedale Sant'Anna, Ferrara, Italy. 4. Unità Operativa Complessa Ematologia con Talassemia, Azienda di Rilievo Nazionale ed Alta Specializzazione Ospedali Civico Di Cristina Benfratelli, Palermo, Italy. 5. Struttura Semplice di Microcitemia, Ospedale "SS. Annunziata" ASL Taranto, Taranto, Italy. 6. Centro Microcitemie, Azienda Ospedaliera "Bianchi-Melacrino-Morelli," Reggio Calabria, Italy. 7. Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale "Antonio Cardarelli," Napoli, Italy. 8. Ematologia Microcitemia, Ospedale San Giovanni di Dio-Azienda Sanitaria Provinciale Crotone, Crotone, Italy. 9. Centro di Microcitemia, Unità Operativa Ematologia, Azienda Ospedaliera Cosenza, Cosenza, Italy. 10. Clinica di Emato-Oncologia Pediatrica, Dipartimento di Salute della Donna e del Bambino, Azienda Ospedaliero di Padova-Università di Padova, Padova, Italy. 11. Centro Talassemie ed Emoglobinopatie, Ospedale "Meyer," Firenze, Italy. 12. Centro Microcitemia, Day Hospital Thalassemia, Poliambulatorio "Giovanni Paolo II," Ospedale Casa Sollievo della Sofferenza IRCCS, San Giovanni Rotondo, Italy. 13. Unità Operativa Complessa di ImmunoEmatologia, Dipartimenti Assistenziali Integrati di Pediatria e Neuropsiachiatria Infantile, Roma, Italy. 14. Ematologia con Trapianto-Servizio Regionale Talassemie, Dipartimento dell'Emergenza e dei Trapianti d'Organo, Azienda Universitaria Ospedaliera Consorziale - Policlinico Bari, Bari, Italy. 15. Cardiologia con UTIC, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy. 16. Unità Operativa Complessa di Radiologia, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico Di Cristina Benfratelli, Palermo, Italy. 17. Struttura Complessa di Cardioradiologia-UTIC, Presidio Ospedaliero "Giovanni Paolo II," Lamezia Terme, Italy. 18. Diagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, Lagosanto, Italy. 19. Pediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy.
Abstract
OBJECTIVE: We systematically explored the link of pancreatic iron with glucose metabolism and with cardiac complications in a cohort of 1,079 patients with thalassemia major (TM) enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. RESEARCH DESIGN AND METHODS: MRI was used to quantify iron overload (T2* technique) and cardiac function (cine images) and to detect macroscopic myocardial fibrosis (late gadolinium enhancement technique). Glucose metabolism was assessed by the oral glucose tolerance test (OGTT). RESULTS: Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with impaired fasting glucose, impaired glucose tolerance, and diabetes. A pancreas T2* <13.07 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for disturbances of glucose metabolism and for cardiac iron. Patients with myocardial fibrosis showed significantly lower pancreas T2* values. Patients with cardiac complications had significantly lower pancreas T2* values. No patient with arrhythmias/heart failure had a normal global pancreas T2*. CONCLUSIONS: Pancreatic iron is a powerful predictor not only for glucose metabolism but also for cardiac iron and complications, supporting the close link between pancreatic iron and heart disease and the need to intensify iron chelation therapy to prevent both alterations of glucose metabolism and cardiac iron accumulation.
OBJECTIVE: We systematically explored the link of pancreatic iron with glucose metabolism and with cardiac complications in a cohort of 1,079 patients with thalassemia major (TM) enrolled in the Extension-Myocardial Iron Overload in Thalassemia (E-MIOT) project. RESEARCH DESIGN AND METHODS: MRI was used to quantify iron overload (T2* technique) and cardiac function (cine images) and to detect macroscopic myocardial fibrosis (late gadolinium enhancement technique). Glucose metabolism was assessed by the oral glucose tolerance test (OGTT). RESULTS:Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with impaired fasting glucose, impaired glucose tolerance, and diabetes. A pancreas T2* <13.07 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for disturbances of glucose metabolism and for cardiac iron. Patients with myocardial fibrosis showed significantly lower pancreas T2* values. Patients with cardiac complications had significantly lower pancreas T2* values. No patient with arrhythmias/heart failure had a normal global pancreas T2*. CONCLUSIONS:Pancreaticiron is a powerful predictor not only for glucose metabolism but also for cardiac iron and complications, supporting the close link between pancreaticiron and heart disease and the need to intensify iron chelation therapy to prevent both alterations of glucose metabolism and cardiac iron accumulation.
Authors: Antonella Meloni; Laura Pistoia; Paolo Ricchi; Maria Caterina Putti; Maria Rita Gamberini; Liana Cuccia; Giuseppe Messina; Francesco Massei; Elena Facchini; Riccardo Righi; Stefania Renne; Giuseppe Peritore; Vincenzo Positano; Filippo Cademartiri Journal: J Pers Med Date: 2022-03-04