Cardiomyopathy
Quantification of Myocardial Iron Deficiency in Nonischemic Heart Failure by Cardiac T2* Magnetic Resonance Imaging

https://doi.org/10.1016/j.amjcard.2013.11.061Get rights and content

The aim of this study was to use T2* cardiac magnetic resonance (CMR) imaging to quantify myocardial iron content in patients with heart failure (HF) and to investigate the relation between iron content, cardiac function, and the cause of HF. CMR data were analyzed from 167 patients with nonischemic and 31 with ischemic HF and 50 patients with normal ventricular function. Short-axis T2* imaging was accomplished using 3-T scanner and multiecho gradient-echo sequence. Myocardial T2* value (M-T2*) was calculated by fitting the signal intensity data for the mid–left ventricular (LV) septum to a decay curve. Patients with nonischemic HF were categorized into patients with LV ejection fraction (LVEF) <35% or ≥35%. The relation between nonischemic HF with LVEF <35% and the risk for major adverse cardiac events was analyzed by multivariate logistic regression analysis using M-T2* and HF biomarkers. M-T2* was significantly greater for patients with nonischemic HF (LVEF <35%: 29 ± 7 ms, LVEF ≥35%: 26 ± 5 ms) than for patients with normal LV function (22 ± 3 ms, p <0.0001) or ischemic HF (22 ± 4 ms, p <0.001). The odds ratio was 1.21 for M-T2* (p <0.0001) and 1.0015 for brain natriuretic peptide (p <0.0001) in relation to nonischemic HF with LVEF <35%. Furthermore, this value was 0.96 for systolic blood pressure (p = 0.012) and 1.02 for M-T2* (p = 0.03) in relation to the risk for major adverse cardiac events in patients with nonischemic HF. In conclusion, T2* CMR demonstrated the robust relation between myocardial iron deficiency and nonischemic HF. M-T2* is a biomarker that can predict adverse cardiac function in patients with nonischemic HF.

Section snippets

Methods

Two hundred twenty-eight consecutive patients who had been admitted to our hospital from June 2010 to March 2013 with symptomatic congestive HF and echocardiographic left ventricular ejection fraction (LVEF) <50% were prospectively enrolled in this study. Congestive HF was diagnosed by the following clinical symptoms and signs according to the Framingham criteria: typical symptoms, neck vein distension, peripheral edema, lung rales, S3 gallop, and tachycardia together with representative chest

Results

T2* value had significant correlations with LV functional parameters (LV end-diastolic volume index, LV end-systolic volume index, and LVEF), which were observed in all patients. There were weak correlations between the T2* value and age and between T2* value and BNP. No correlation between T2* value and any other factor was observed (Table 2). No difference in T2* value between with and without LGE was observed in each patient group (Table 3). T2* value was significantly greater for patients

Discussion

The present study quantified myocardial iron content in patients with moderate to advanced HF and normal ventricular function using T2* CMR. T2* value was correlated with LV functional parameters and was significantly greater in patients with nonischemic HF than ischemic HF or patients with normal function. Furthermore, among patients with nonischemic HF, multivariate regression analysis showed a significant correlation between T2* value and LVEF. These results suggest that myocardial iron

Disclosures

Drs. Nagao and Kawanami received research grants from Bayer HealthCare Japan (Tokyo, Japan) and Philips Electronics Japan. Mr. Takemura is an employee of Philips Electronics Japan (Tokyo, Japan). The other authors have no conflicts of interest to disclose.

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This work was supported by grant 25461831 from the Japan Society for the Promotion of Science (JSPS) KAKENHI (Tokyo, Japan).

See page 1029 for disclosure information.

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