Abstract
Abstract 4265
Delayed enhancement (DE) cardiac magnetic resonance (CMR) technique with intravenous administration of gadolinium (Gd) chelates contrast agents is the only validated non-invasive approach for detecting myocardial fibrosis (Mahrholdt H et al, Eur Heart J 2005). This technique has been confirmed safe in patients with hemoglobinopathies (Meloni A et al, Haematologica 2009). In thalassemia major (TM), myocardial fibrosis has been detected using the DE technique and a positive correlation with anti-HCV antibodies has been described (Pepe A et al, Heart 2009). However, HCV-induced cardiomyopathy is still controversial (Matsumori A et al. J Card Fail 2006). The aim of our study was to verify a possible correlation between myocardial fibrosis detected by DE CMR and chronic HCV infection in a large retrospective cohort of TM patients.
We analysed 434 TM patients (233 males, mean age 31±9 years) consecutively enrolled in the MIOT (Myocardial Iron Overload in Thalassemia) network (Ramazzotti A et al, JMRI 2009). DE images were acquired from 10 to 18 minutes, after intravenous administration of Gadobutrol. DE was evaluated visually using a two-point scale (absent or present) and enhancement was considered present whenever it was visualized in two different views (Pepe A et al, Heart 2009). HCV-RNA tests were sensitive to detect more than 50 copies/ml.
Figure 1 represents the flow chart of the test results in the 434 TM patients. Ninety out of 434 TM patients (21%) were found to have myocardial fibrosis by DE CMR technique. Chronic hepatitis C (CHC) group was composed by HCV-RNA positive patients plus the patients with a previous diagnosis of CHC successfully treated by alpha-interferon for obtaining a sustained virological response (SVR). There was a significant correlation between the presence of myocardial fibrosis and CHC (P=0.026).
Our finding supports the hypothesis that HCV infection can be involved in the pathogenesis of myocardial fibrosis in the multitransfused TM patients, who could therefore benefit from therapeutic interventions directed towards the eradication of HCV.
Flow chart of the test results.
No relevant conflicts of interest to declare.
