Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major
© 2023. The Author(s)..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:33 |
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| Enthalten in: |
European radiology - 33(2023), 10 vom: 01. Okt., Seite 7215-7225 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Meloni, Antonella [VerfasserIn] |
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| Links: |
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| Themen: |
AU0V1LM3JT |
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| Anmerkungen: |
Date Completed 21.09.2023 Date Revised 13.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00330-023-09630-z |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM35618787X |
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| 100 | 1 | |a Meloni, Antonella |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 21.09.2023 | ||
| 500 | |a Date Revised 13.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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) | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Magnetic resonance imaging | |
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| 650 | 4 | |a Thalassemia | |
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| 650 | 7 | |a Gadolinium |2 NLM | |
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| 650 | 7 | |a Glucose |2 NLM | |
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| 700 | 1 | |a Nobile, Mario |e verfasserin |4 aut | |
| 700 | 1 | |a Keilberg, Petra |e verfasserin |4 aut | |
| 700 | 1 | |a Positano, Vincenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Santarelli, Maria Filomena |e verfasserin |4 aut | |
| 700 | 1 | |a Pistoia, Laura |e verfasserin |4 aut | |
| 700 | 1 | |a Spasiano, Anna |e verfasserin |4 aut | |
| 700 | 1 | |a Casini, Tommaso |e verfasserin |4 aut | |
| 700 | 1 | |a Putti, Maria Caterina |e verfasserin |4 aut | |
| 700 | 1 | |a Cuccia, Liana |e verfasserin |4 aut | |
| 700 | 1 | |a Bitti, Pier Paolo |e verfasserin |4 aut | |
| 700 | 1 | |a Messina, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Peritore, Giuseppe |e verfasserin |4 aut | |
| 700 | 1 | |a Renne, Stefania |e verfasserin |4 aut | |
| 700 | 1 | |a Grassedonio, Emanuele |e verfasserin |4 aut | |
| 700 | 1 | |a Quaia, Emilio |e verfasserin |4 aut | |
| 700 | 1 | |a Cademartiri, Filippo |e verfasserin |4 aut | |
| 700 | 1 | |a Pepe, Alessia |e verfasserin |4 aut | |
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