The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study
In thalassemia major, pancreatic iron was demonstrated as a powerful predictor not only for the alterations of glucose metabolism but also for cardiac iron, fibrosis, and complications, supporting a profound link between pancreatic iron and heart disease. We determined for the first time the prevale...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/10/23/5561 |
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| author | Antonella Meloni Laura Pistoia Maria Rita Gamberini Paolo Ricchi Valerio Cecinati Francesco Sorrentino Liana Cuccia Massimo Allò Riccardo Righi Priscilla Fina Ada Riva Stefania Renne Giuseppe Peritore Stefano Dalmiani Vincenzo Positano Emilio Quaia Filippo Cademartiri Alessia Pepe |
| author_facet | Antonella Meloni Laura Pistoia Maria Rita Gamberini Paolo Ricchi Valerio Cecinati Francesco Sorrentino Liana Cuccia Massimo Allò Riccardo Righi Priscilla Fina Ada Riva Stefania Renne Giuseppe Peritore Stefano Dalmiani Vincenzo Positano Emilio Quaia Filippo Cademartiri Alessia Pepe |
| author_sort | Antonella Meloni |
| collection | DOAJ |
| description | In thalassemia major, pancreatic iron was demonstrated as a powerful predictor not only for the alterations of glucose metabolism but also for cardiac iron, fibrosis, and complications, supporting a profound link between pancreatic iron and heart disease. We determined for the first time the prevalence of pancreatic iron overload (IO) in thalassemia intermedia (TI) and systematically explored the link between pancreas T2* values and glucose metabolism and cardiac outcomes. We considered 221 beta-TI patients (53.2% females, 42.95 ± 13.74 years) consecutively enrolled in the Extension–Myocardial Iron Overload in Thalassemia project. Magnetic Resonance Imaging was used to quantify IO (T2* technique) and biventricular function and to detect replacement myocardial fibrosis. The glucose metabolism was assessed by the oral glucose tolerance test (OGTT). Pancreatic IO was more frequent in regularly transfused (<i>N</i> = 145) than in nontransfused patients (67.6% vs. 31.6%; <i>p</i> < 0.0001). In the regular transfused group, splenectomy and hepatitis C virus infection were both associated with high pancreatic siderosis. Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with altered OGTT. A pancreas T2* < 17.9 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for cardiac iron. Pancreas T2* values were not associated to biventricular function, replacement myocardial fibrosis, or cardiac complications. Our findings suggest that in the presence of pancreatic IO, it would be prudent to initiate or intensify iron chelation therapy to prospectively prevent both disturbances of glucose metabolism and cardiac iron accumulation. |
| first_indexed | 2024-03-10T04:51:10Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T04:51:10Z |
| publishDate | 2021-11-01 |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-33b3969d964c4256b0a37a0b3bda0b0f2023-11-23T02:35:55ZengMDPI AGJournal of Clinical Medicine2077-03832021-11-011023556110.3390/jcm10235561The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational StudyAntonella Meloni0Laura Pistoia1Maria Rita Gamberini2Paolo Ricchi3Valerio Cecinati4Francesco Sorrentino5Liana Cuccia6Massimo Allò7Riccardo Righi8Priscilla Fina9Ada Riva10Stefania Renne11Giuseppe Peritore12Stefano Dalmiani13Vincenzo Positano14Emilio Quaia15Filippo Cademartiri16Alessia Pepe17Department of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, ItalyDepartment of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, ItalyUnità Operativa di Day Hospital della Talassemia e delle Emoglobinopatie, Dipartimento della Riproduzione e dell’Accrescimento, Azienda Ospedaliero-Universitaria “S. Anna”, 44124 Cona, ItalyUnità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale, 80131 Napoli, ItalyStruttura Semplice di Microcitemia, Ospedale “SS. Annunziata” Azienda Sanitaria Locale Taranto, 74123 Taranto, ItalyUnità Operativa Semplice Dipartimentale Day Hospital Talassemici, Ospedale “Sant’Eugenio”, 00143 Roma, ItalyUnità Operativa Complessa Ematologia con Talassemia, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico “Benfratelli-Di Cristina”, 90127 Palermo, ItalyEmatologia Microcitemia, Ospedale San Giovanni di Dio—Azienda Sanitaria Provinciale di Crotone, 88900 Crotone, ItalyDiagnostica per Immagini e Radiologia Interventistica, Ospedale del Delta, 44023 Lagosanto, ItalyUnità Operativa Complessa Diagnostica per Immagini, Ospedale “Sandro Pertini”, 00157 Roma, ItalyStruttura Complessa di Radiologia, Ospedale “SS. Annunziata” Azienda Sanitaria Locale Taranto, 74100 Taranto, ItalyStruttura Complessa di Cardioradiologia-Unità di Terapia Intensiva Cardiologica, Presidio Ospedaliero “Giovanni Paolo II”, 88046 Lamezia Terme, ItalyUnità Operativa Complessa di Radiologia, Azienda di Rilievo Nazionale ad Alta Specializzazione Civico “Benfratelli-Di Cristina”, 90127 Palermo, ItalyUnità Operativa Complessa Infotelematica Translational BioInformatics and eHealth, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, ItalyDepartment of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, ItalyDepartment of Medicine, Institute of Radiology, University of Padua, 35100 Padua, ItalyDepartment of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, ItalyDepartment of Radiology, Fondazione Toscana Gabriele Monasterio, 56124 Pisa, ItalyIn thalassemia major, pancreatic iron was demonstrated as a powerful predictor not only for the alterations of glucose metabolism but also for cardiac iron, fibrosis, and complications, supporting a profound link between pancreatic iron and heart disease. We determined for the first time the prevalence of pancreatic iron overload (IO) in thalassemia intermedia (TI) and systematically explored the link between pancreas T2* values and glucose metabolism and cardiac outcomes. We considered 221 beta-TI patients (53.2% females, 42.95 ± 13.74 years) consecutively enrolled in the Extension–Myocardial Iron Overload in Thalassemia project. Magnetic Resonance Imaging was used to quantify IO (T2* technique) and biventricular function and to detect replacement myocardial fibrosis. The glucose metabolism was assessed by the oral glucose tolerance test (OGTT). Pancreatic IO was more frequent in regularly transfused (<i>N</i> = 145) than in nontransfused patients (67.6% vs. 31.6%; <i>p</i> < 0.0001). In the regular transfused group, splenectomy and hepatitis C virus infection were both associated with high pancreatic siderosis. Patients with normal glucose metabolism showed significantly higher global pancreas T2* values than patients with altered OGTT. A pancreas T2* < 17.9 ms predicted an abnormal OGTT. A normal pancreas T2* value showed a 100% negative predictive value for cardiac iron. Pancreas T2* values were not associated to biventricular function, replacement myocardial fibrosis, or cardiac complications. Our findings suggest that in the presence of pancreatic IO, it would be prudent to initiate or intensify iron chelation therapy to prospectively prevent both disturbances of glucose metabolism and cardiac iron accumulation.https://www.mdpi.com/2077-0383/10/23/5561thalassemia intermediapancreasiron overloadmagnetic resonance imaginingglucose metabolism |
| spellingShingle | Antonella Meloni Laura Pistoia Maria Rita Gamberini Paolo Ricchi Valerio Cecinati Francesco Sorrentino Liana Cuccia Massimo Allò Riccardo Righi Priscilla Fina Ada Riva Stefania Renne Giuseppe Peritore Stefano Dalmiani Vincenzo Positano Emilio Quaia Filippo Cademartiri Alessia Pepe The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study Journal of Clinical Medicine thalassemia intermedia pancreas iron overload magnetic resonance imagining glucose metabolism |
| title | The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study |
| title_full | The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study |
| title_fullStr | The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study |
| title_full_unstemmed | The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study |
| title_short | The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study |
| title_sort | link of pancreatic iron with glucose metabolism and cardiac iron in thalassemia intermedia a large multicenter observational study |
| topic | thalassemia intermedia pancreas iron overload magnetic resonance imagining glucose metabolism |
| url | https://www.mdpi.com/2077-0383/10/23/5561 |
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