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- Title
Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major.
- Authors
Meloni, Antonella; Nobile, Mario; Keilberg, Petra; Positano, Vincenzo; Santarelli, Maria Filomena; Pistoia, Laura; Spasiano, Anna; Casini, Tommaso; Putti, Maria Caterina; Cuccia, Liana; Bitti, Pier Paolo; Messina, Giuseppe; Peritore, Giuseppe; Renne, Stefania; Grassedonio, Emanuele; Quaia, Emilio; Cademartiri, Filippo; Pepe, Alessia
- Abstract
Objectives: This multicenter study assessed the extent of pancreatic fatty replacement and its correlation with demographics, iron overload, glucose metabolism, and cardiac complications in a cohort of well-treated patients with thalassemia major (TM). Methods: We considered 308 TM patients (median age: 39.79 years; 182 females) consecutively enrolled in the Extension-Myocardial Iron Overload in Thalassemia Network. Magnetic resonance imaging was used to quantify iron overload (IO) and pancreatic fat fraction (FF) by T2* technique, cardiac function by cine images, and to detect replacement myocardial fibrosis by late gadolinium enhancement technique. The glucose metabolism was assessed by the oral glucose tolerance test. Results: Pancreatic FF was associated with age, body mass index, and history of hepatitis C virus infection. Patients with normal glucose metabolism showed a significantly lower pancreatic FF than patients with impaired fasting glucose (p = 0.030), impaired glucose tolerance (p < 0.0001), and diabetes (p < 0.0001). A normal pancreatic FF (< 6.6%) showed a negative predictive value of 100% for abnormal glucose metabolism. A pancreatic FF > 15.33% predicted the presence of abnormal glucose metabolism. Pancreas FF was inversely correlated with global pancreas and heart T2* values. A normal pancreatic FF showed a negative predictive value of 100% for cardiac iron. Pancreatic FF was significantly higher in patients with myocardial fibrosis (p = 0.002). All patients with cardiac complications had fatty replacement, and they showed a significantly higher pancreatic FF than complications-free patients (p = 0.002). Conclusion: Pancreatic FF is a risk marker not only for alterations of glucose metabolism, but also for cardiac iron and complications, further supporting the close link between pancreatic and cardiac disease. Key Points: • In thalassemia major, pancreatic fatty replacement by MRI is a frequent clinical entity, predicted by a pancreas T2* < 20.81 ms and associated with a higher risk of alterations in glucose metabolism. • In thalassemia major, pancreatic fatty replacement is a strong risk marker for cardiac iron, replacement fibrosis, and complications, highlighting a deep connection between pancreatic and cardiac impairment.
- Subjects
GLUCOSE tolerance tests; BETA-Thalassemia; GLUCOSE metabolism; HEPATITIS C; IRON metabolism; HEART metabolism
- Publication
European Radiology, 2023, Vol 33, Issue 10, p7215
- ISSN
0938-7994
- Publication type
Article
- DOI
10.1007/s00330-023-09630-z