Back to Search
Start Over
Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major.
- Source :
-
European radiology [Eur Radiol] 2023 Oct; Vol. 33 (10), pp. 7215-7225. Date of Electronic Publication: 2023 Apr 28. - Publication Year :
- 2023
-
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).<br />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.<br />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).<br />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.<br />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.<br /> (© 2023. The Author(s).)
- Subjects :
- Female
Humans
Adult
Iron metabolism
Contrast Media metabolism
Liver pathology
Gadolinium
Magnetic Resonance Imaging methods
Myocardium pathology
Glucose metabolism
Fibrosis
beta-Thalassemia complications
beta-Thalassemia diagnostic imaging
Iron Overload complications
Iron Overload diagnostic imaging
Cardiomyopathies complications
Heart Diseases complications
Pancreatic Diseases complications
Subjects
Details
- Language :
- English
- ISSN :
- 1432-1084
- Volume :
- 33
- Issue :
- 10
- Database :
- MEDLINE
- Journal :
- European radiology
- Publication Type :
- Academic Journal
- Accession number :
- 37115218
- Full Text :
- https://doi.org/10.1007/s00330-023-09630-z