We evaluated in thalassemia major (TM) if the cardiac efficacy of the three iron chelators (Desferrioxamine, Deferiprone, and Deferasirox) was influenced by hepatic iron levels over a follow up of 18 months. In patients treated with Deferasirox and Deferiprone percentage changes in cardiac R2* over 18 months were associated with final liver iron concentration (LIC) and percentage LIC changes. In no chelation group percentage changes in cardiac R2* were influenced by initial LIC or initial cardiac R2*.
We identified 3 groups of patients: 47 treated with deferasirox (DFX), 11 treated with deferiprone (DFP) and 40 treated with desferrioxamine (DFO).
Percentage changes in cardiac R2* values correlated with changes in LIC in both DFX (R=0.469; P=0.001) and DFP (R=0.775; P=0.007) groups. All patients in these two groups who lowered their LIC by more than 50% improved their cardiac iron (see Figure 1). Percentage changes in cardiac R2* were linearly associated to the log of final LIC values in both DFX (R=0.437; P=0.002) and DFP groups (R=0.909; P<0.0001). Percentage changes in cardiac R2* were not predicted by initial cardiac R2* and LIC values.
In each chelation group patients were divided in subgroups according to the severity of baseline hepatic iron overload (no, mild, moderate, and severe IO). The changes in cardiac R2* were comparable among subgroups (Figure 2).
In patients treated with DFX and DFP percentage changes in cardiac R2* over 18 months were associated with final LIC and percentage LIC changes.
In no chelation group percentage changes in cardiac R2* were influenced by initial LIC or initial cardiac R2*.
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