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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...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658115/ https://www.ncbi.nlm.nih.gov/pubmed/34884261 http://dx.doi.org/10.3390/jcm10235561 |
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author | Meloni, Antonella Pistoia, Laura Gamberini, Maria Rita Ricchi, Paolo Cecinati, Valerio Sorrentino, Francesco Cuccia, Liana Allò, Massimo Righi, Riccardo Fina, Priscilla Riva, Ada Renne, Stefania Peritore, Giuseppe Dalmiani, Stefano Positano, Vincenzo Quaia, Emilio Cademartiri, Filippo Pepe, Alessia |
author_facet | Meloni, Antonella Pistoia, Laura Gamberini, Maria Rita Ricchi, Paolo Cecinati, Valerio Sorrentino, Francesco Cuccia, Liana Allò, Massimo Righi, Riccardo Fina, Priscilla Riva, Ada Renne, Stefania Peritore, Giuseppe Dalmiani, Stefano Positano, Vincenzo Quaia, Emilio Cademartiri, Filippo Pepe, Alessia |
author_sort | Meloni, Antonella |
collection | PubMed |
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 (N = 145) than in nontransfused patients (67.6% vs. 31.6%; p < 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. |
format | Online Article Text |
id | pubmed-8658115 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-86581152021-12-10 The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study Meloni, Antonella Pistoia, Laura Gamberini, Maria Rita Ricchi, Paolo Cecinati, Valerio Sorrentino, Francesco Cuccia, Liana Allò, Massimo Righi, Riccardo Fina, Priscilla Riva, Ada Renne, Stefania Peritore, Giuseppe Dalmiani, Stefano Positano, Vincenzo Quaia, Emilio Cademartiri, Filippo Pepe, Alessia J Clin Med Article 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 (N = 145) than in nontransfused patients (67.6% vs. 31.6%; p < 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. MDPI 2021-11-26 /pmc/articles/PMC8658115/ /pubmed/34884261 http://dx.doi.org/10.3390/jcm10235561 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Meloni, Antonella Pistoia, Laura Gamberini, Maria Rita Ricchi, Paolo Cecinati, Valerio Sorrentino, Francesco Cuccia, Liana Allò, Massimo Righi, Riccardo Fina, Priscilla Riva, Ada Renne, Stefania Peritore, Giuseppe Dalmiani, Stefano Positano, Vincenzo Quaia, Emilio Cademartiri, Filippo Pepe, Alessia The Link of Pancreatic Iron with Glucose Metabolism and Cardiac Iron in Thalassemia Intermedia: A Large, Multicenter Observational Study |
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 | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8658115/ https://www.ncbi.nlm.nih.gov/pubmed/34884261 http://dx.doi.org/10.3390/jcm10235561 |
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