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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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