Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major
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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.
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Le contrôle bibliographique ouvert
DOI retrouvé dans Crossref DOI retrouvé ; titre concordant.
- Titre Crossref
- Pancreatic fatty replacement as risk marker for altered glucose metabolism and cardiac iron and complications in thalassemia major
- Date Crossref
- 28/04/2023
- Éditeur
- Springer Science and Business Media LLC
- Type
- journal-article
Ce recoupement confirme des métadonnées liées au DOI. Il ne confirme ni la méthode ni les conclusions de l’étude, et il ne compte pas comme une seconde source scientifique indépendante.
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Fondazione Toscana Gabriele Monasterio pays non établi dans la noticeInstitution
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Regione Toscana pays non établi dans la noticeOrganisme public
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Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo Sezione Di Scienze Radiologiche - Dipartimento Di Biopatologia E Biotecnologie Mediche pays non établi dans la noticeÉtablissement de santé
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Istituto di Fisiologia Clinica pays non établi dans la noticeStructure de recherche
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Azienda ospedaliera "Bianchi-Melacrino-Morelli" pays non établi dans la noticeÉtablissement de santé
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University of Padua Institute of Radiology pays non établi dans la noticeUniversité ou école supérieure
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Department of Radiology pays non établi dans la noticeInstitution
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Fondazione Toscana Gabriele Monasterio, Regione Toscana et Sezione Di Scienze Radiologiche - Dipartimento Di Biopatologia E Biotecnologie Mediche — Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone" di Palermo, avec 9 autres affiliations.
Une affiliation ne permet pas de déduire la nationalité d’un auteur.