Cardiovascular T2-star (T2*) magnetic resonance for the early diagnosis ofmyocardial iron overload

Aims To develop and validate a non-invasive method for measuring myocardial iron in order to allow diagnosis and treatment before overt cardiomyopathy and failure develops. Methods and Results We have developed a new magnetic resonance T2-star (T2* ) technique for the measurement of tissue iron, with validation to chemical estimation of iron in patients undergoing liver biopsy. To assess the clin ical value of this technique, we subsequently correlated myocardial iron me asured by this T2* technique with ventricular function in 106 patients with thalassaemia major. There was a significant, curvilinear, inverse correlat ion between iron concentration by biopsy and liver T2* (r=0(.)93, P <0(.)00 01). Inter-study cardiac reproducibility was 5(.)0%. As myocardial iron inc reased. there was a progressive decline in ejection fraction (r=0(.)61, P < 0(.)001). All patients with ventricular dysfunction had a myocardial T2* of < 20 ms. There was no significant correlation between myocardial T2* and t he conventional parameters of iron status, serum ferritin and liver iron. M ultivariate analysis of clinical parameters to predict the requirement for cardiac medication identified myocardial T2* as the most significant variab le (odds ratio 0(.)79, P <0(.)002). Conclusions Myocardial iron deposition can be reproducibly quantified using myocardial T2* and this is the most significant variable for predicting th e need for ventricular dysfunction treatment. Myocardial iron content canno t be predicted from serum ferritin or liver iron, and conventional assessme nts of cardiac function can only detect those with advanced disease. Early intensification of iron chelation therapy, guided by this technique. should reduce mortality from this reversible cardiomyopathy. (C) 2001 The Europea n Society of Cardiology.