Incorporation of Cardiac MRI T2 technique for the detection of cardiac iron into Indian guidelines

The All India Institute of Medical Sciences on Wednesday said that the incorporation of Cardiac MRI T2 technique for the detection of cardiac iron into Indian guidelines or SOP for mass screening in thalassemia patients. Cardiac iron deposition is the main cause of cardiac dysfunction and deaths in 50-70 per cent of thalassemia patients.

During the process of blood transfusions to save lives, excess iron is delivered in the body and deposited in organs like liver, heart, pancreas and causes deaths in thalassemia patients. Excess iron needs to be removed by timely chelation therapy.

Dr. Priya Jagia, Cardiovascular Radiology Head, AIIMS, said that Serum ferritin is the most widely used marker to detect iron overload in thalassemia patient, but multiple studies have shown serum ferritin levels to be a poor predictor of cardiac iron deposition. This unique MRI T2 protocol can measure cardiac iron in about eight minutes.

“We are using a rapid Cardiac MRI method of cardiac iron assessment. This unique MRI T2 protocol can measure cardiac iron in around 8 minutes. Thus 50 patients can be scanned easily within a day. This service is currently being provided free of cost to all thalassemia patients at AIIMS, as part of AIIMS-UCL collaboration project”, said Dr Jagia.

Dr Jagia said that recent studies from AIIMS have confirmed that additional novel MRI techniques, such as T1 mapping can be used pick up even small amounts of cardiac iron while MR strain analysis can detect sub-clinical abnormal cardiac contraction even when echocardiography is normal in these patients with overload. “Cardiac MRI T2 is of paramount importance for detection of cardiac iron and can guide chelation therapy for prevention of cardiac complications. Incorporation of T2 MRI into Indian guidelines/SOP is necessary and rapid MRI can be used for mass screening for cardiac iron in thalassemia patients”, she added.

“If chelation therapy for iron overload is guided by a rapid cardiac MR technique in which iron content of the heart can be measured in just 8 minutes, we expect a 80% reduction in mortality as evidenced in the UK cohort,” Dr Jagia said.