Correlation of Magnesium Level with Cardiac and Hepatic Hemosiderosis Measured by T2*MRI Technique and Age in Patients with Thalassemia Major
-
Ali Ghasemi
,
Kazem Ghaffari
,
Fatemeh Hoseini
,
Aziz Eghbali
,
Nooshin Sajadei
,
Vahid Falahati
,
Yazdan Ghandi
Abstract
Background: Given the association of hypomagnesemia with cardiac arrhythmia, the aim of this study was to investigate the relationship between serum magnesium levels with age and T2* magnetic resonance imaging (MRI) findings of the heart and liver in patients with thalassemia major (TM).
Materials and Methods: In a descriptive cross-sectional study, a total of 62 patients with β-thalassemia major aged 11-48 years were selected at the Amir-Kabir Hospital, Arak, Iran. Serum magnesium, ferritin, and iron levels of patients were measured, and the rate of cardiac and hepatic hemosiderosis of patients was extracted according to the routine T2*MRI method.
Results: The mean age of the patients at diagnosis was 32.6 years. The comparison of TM patients with and without hepatic/cardiac hemosiderosis demonstrated that mean levels of serum ferritin, serum iron, and age were significantly higher in TM patients with cardiac hemosiderosis than in hepatic/cardiac non-hemosiderosis (P < 0.05); however, there was no significant difference in mean levels of serum magnesium in TM patients with and without hepatic/cardiac hemosiderosis (P = 0.279). Interestingly, the correlation of age with serum magnesium levels in TM patients revealed a statistically significant and moderate inverse correlation (r = -0.56, P = 0.013).
Conclusion: Hypomagnesemia may occur in a time-dependent manner. It is recommended that, in addition to cardiac and hepatic T2*MRI, serum magnesium levels be measured by using magnesium replacement if necessary.
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2. Nasiri A, Rahimi Z, Vaisi-Raygani A. Hemoglobinopathies in Iran: an updated review. Int J Hematol Oncol Stem Cell Res. 2020;14(2):140-150.
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9. Bordbar M, Bozorgi H, Saki F, et al. Prevalence of endocrine disorders and their associated factors in transfusion-dependent thalassemia patients: a historical cohort study in Southern Iran. J Endocrinol Invest. 2019;42(12):1467-76.
10. Auger D, Pennell DJ. Cardiac complications in thalassemia major. Ann N Y Acad Sci. 2016;1368(1):56-64.
11. Pennell D, Udelson J, Arai A, et al. American Heart Association Committee on Heart Failure and Transplantation of the Council on Clinical Cardiology and Council on Cardiovascular Radiology and Imaging. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation. 2013;128(3):281-308.
12. Chrysant SG. Proton pump inhibitor-induced hypomagnesemia complicated with serious cardiac arrhythmias. Expert Rev Cardiovasc Ther. 2019;17(5):345-51.
13. Al-Samarrai AH, Adaay MH, Al-Tikriti KA, et al. Evaluation of some essential element levels in thalassemia major patients in Mosul district, Iraq. Saudi Med J. 2008;29(1):94-7.
14. Wood JC. Guidelines for quantifying iron overload. Hematology Am Soc Hematol Educ Program. 2014;2014(1):210-5.
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16. Fischer R, Harmatz PR. Non-invasive assessment of tissue iron overload. Hematology Am Soc Hematol Educ Program. 2009;215-21.
17. Youssef DM, Fawzy Mohammad F, Ahmed Fathy A, et al. Assessment of Hepatic and Pancreatic Iron Overload in Pediatric Beta-Thalassemic Major Patients by Weighted Gradient Echo Magnetic Resonance Imaging. ISRN Hematol . 2013;2013:496985.
18. Kirk P, Roughton M, Porter JB, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation. 2009;120(20):1961-8.
19. Riis P. Thirty years of bioethics: the Helsinki Declaration 1964-2003. New Rev Bioeth. 2003;1(1):15-25.
20. Modell B, Khan M, Darlison M, et al. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2008;10(1):42.
21. Hansen B-A, Bruserud Ø. Hypomagnesemia in critically ill patients. J Intensive Care. 2018;6:21.
22. Marcus N, Garty BZ. Transient Hypoparathyroidism Due to Amphotericin B—Induced Hypomagnesemia in a Patient with β–Thalassemia. Ann Pharmacother. 2001;35(9):1042-4.
23. Fung EB, Xu Y, Trachtenberg F, et al. Inadequate dietary intake in patients with thalassemia. J Acad Nutr Diet. 2012;112(7):980-90.
24. Şahin A, Er EÖ, Öz E, et al. Sodium, Magnesium, Calcium, Manganese, Iron, Copper, and Zinc in Serums of Beta Thalassemia Major Patients. Biol Trace Elem Res. 2021 Mar;199(3):888-894.
25. Genc GE, Ozturk Z, Gumuslu S, et al. Mineral levels in Thalassaemia major patients using different iron chelators. Biol Trace Elem Res. 2016;170(1):9-16.
26. Azarkeivan A, Hashemieh M, Shirkavand A, et al. Correlation between heart, liver and pancreas hemosiderosis measured by MRI T2* among thalassemia major patients from Iran. Arch Iran Med. 2016;19(2):96-100.
27. Soltanpour MS, Davari K. The correlation of cardiac and hepatic hemosiderosis as measured by T2* MRI technique with ferritin levels and hemochromatosis gene mutations in Iranian patients with beta thalassemia major. Oman Med J. 2018;33(1):48-54.
28. Azarkeivan A, Hashemieh M, Akhlaghpoor S, et al. Relation between serum ferritin and liver and heart MRI T2* in beta thalassaemia major patients. East Mediterr Health J. 2013;19(8):727-32.
29. Fragasso A, Ciancio A, Mannarella C, et al. Myocardial iron overload assessed by magnetic resonance imaging (MRI) T2* in multi-transfused patients with thalassemia and acquired anemias. Eur J Intern Med. 2011;22(1):62-5.
30. Yang G, Liu R, Peng P, et al. How early can myocardial iron overload occur in beta thalassemia major? PLoS One. 2014;9(1):e85379.
31. Wu X, Jing Y, Pei F, et al. Value of magnetic resonance imaging T2* tests in detecting heart and liver iron overload in patients with β-thalassemia major. Nan Fang Yi Ke Da Xue Xue Bao. 2013;33(2):249-52.
32. Majd Z, Haghpanah S, Ajami GH, et al. Serum ferritin levels correlation with heart and liver MRI and LIC in patients with transfusion-dependent thalassemia. Iran Red Crescent Med J. 2015;17(4):e24959.
33. Eghbali A, Taherahmadi H, Shahbazi M, et al. Association between serum ferritin level, cardiac and hepatic T2-star MRI in patients with major β-thalassemia. Iran J Ped Hematol Oncol. 2014;4(1):17-21.
2. Nasiri A, Rahimi Z, Vaisi-Raygani A. Hemoglobinopathies in Iran: an updated review. Int J Hematol Oncol Stem Cell Res. 2020;14(2):140-150.
3. Angastiniotis M, Modell B. Global epidemiology of hemoglobin disorders. Ann N Y Acad Sci. 1998;850:251.
4. Ansari-Moghaddam A, Adineh HA, Zareban I, et al. The survival rate of patients with beta-thalassemia major and intermedia and its trends in recent years in Iran. Epidemiol Health. 2018;40:e2018048.
5. Cao A, Galanello R. Beta-thalassemia. Genet Med. 2010;12(2):61-76.
6. Khalifa S, Sheir S, El Magd LA, et al. The kidney in beta-thalassaemia major. Acta Haematol. 1985;74(1):60.
7. Borgna-Pignatti C, Gamberini MR. Complications of thalassemia major and their treatment. Expert Rev Hematol. 2011;4(3):353-66.
8. Badfar G, Mansouri A, Shohani M, et al. Hearing loss in Iranian thalassemia major patients treated with deferoxamine: A systematic review and meta-analysis. Caspian J Intern Med. 2017;8(4):239-249.
9. Bordbar M, Bozorgi H, Saki F, et al. Prevalence of endocrine disorders and their associated factors in transfusion-dependent thalassemia patients: a historical cohort study in Southern Iran. J Endocrinol Invest. 2019;42(12):1467-76.
10. Auger D, Pennell DJ. Cardiac complications in thalassemia major. Ann N Y Acad Sci. 2016;1368(1):56-64.
11. Pennell D, Udelson J, Arai A, et al. American Heart Association Committee on Heart Failure and Transplantation of the Council on Clinical Cardiology and Council on Cardiovascular Radiology and Imaging. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation. 2013;128(3):281-308.
12. Chrysant SG. Proton pump inhibitor-induced hypomagnesemia complicated with serious cardiac arrhythmias. Expert Rev Cardiovasc Ther. 2019;17(5):345-51.
13. Al-Samarrai AH, Adaay MH, Al-Tikriti KA, et al. Evaluation of some essential element levels in thalassemia major patients in Mosul district, Iraq. Saudi Med J. 2008;29(1):94-7.
14. Wood JC. Guidelines for quantifying iron overload. Hematology Am Soc Hematol Educ Program. 2014;2014(1):210-5.
15. Musallam KM, Cappellini MD, Wood JC, et al. Elevated liver iron concentration is a marker of increased morbidity in patients with β thalassemia intermedia. Haematologica. 2011;96(11):1605-12.
16. Fischer R, Harmatz PR. Non-invasive assessment of tissue iron overload. Hematology Am Soc Hematol Educ Program. 2009;215-21.
17. Youssef DM, Fawzy Mohammad F, Ahmed Fathy A, et al. Assessment of Hepatic and Pancreatic Iron Overload in Pediatric Beta-Thalassemic Major Patients by Weighted Gradient Echo Magnetic Resonance Imaging. ISRN Hematol . 2013;2013:496985.
18. Kirk P, Roughton M, Porter JB, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation. 2009;120(20):1961-8.
19. Riis P. Thirty years of bioethics: the Helsinki Declaration 1964-2003. New Rev Bioeth. 2003;1(1):15-25.
20. Modell B, Khan M, Darlison M, et al. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson. 2008;10(1):42.
21. Hansen B-A, Bruserud Ø. Hypomagnesemia in critically ill patients. J Intensive Care. 2018;6:21.
22. Marcus N, Garty BZ. Transient Hypoparathyroidism Due to Amphotericin B—Induced Hypomagnesemia in a Patient with β–Thalassemia. Ann Pharmacother. 2001;35(9):1042-4.
23. Fung EB, Xu Y, Trachtenberg F, et al. Inadequate dietary intake in patients with thalassemia. J Acad Nutr Diet. 2012;112(7):980-90.
24. Şahin A, Er EÖ, Öz E, et al. Sodium, Magnesium, Calcium, Manganese, Iron, Copper, and Zinc in Serums of Beta Thalassemia Major Patients. Biol Trace Elem Res. 2021 Mar;199(3):888-894.
25. Genc GE, Ozturk Z, Gumuslu S, et al. Mineral levels in Thalassaemia major patients using different iron chelators. Biol Trace Elem Res. 2016;170(1):9-16.
26. Azarkeivan A, Hashemieh M, Shirkavand A, et al. Correlation between heart, liver and pancreas hemosiderosis measured by MRI T2* among thalassemia major patients from Iran. Arch Iran Med. 2016;19(2):96-100.
27. Soltanpour MS, Davari K. The correlation of cardiac and hepatic hemosiderosis as measured by T2* MRI technique with ferritin levels and hemochromatosis gene mutations in Iranian patients with beta thalassemia major. Oman Med J. 2018;33(1):48-54.
28. Azarkeivan A, Hashemieh M, Akhlaghpoor S, et al. Relation between serum ferritin and liver and heart MRI T2* in beta thalassaemia major patients. East Mediterr Health J. 2013;19(8):727-32.
29. Fragasso A, Ciancio A, Mannarella C, et al. Myocardial iron overload assessed by magnetic resonance imaging (MRI) T2* in multi-transfused patients with thalassemia and acquired anemias. Eur J Intern Med. 2011;22(1):62-5.
30. Yang G, Liu R, Peng P, et al. How early can myocardial iron overload occur in beta thalassemia major? PLoS One. 2014;9(1):e85379.
31. Wu X, Jing Y, Pei F, et al. Value of magnetic resonance imaging T2* tests in detecting heart and liver iron overload in patients with β-thalassemia major. Nan Fang Yi Ke Da Xue Xue Bao. 2013;33(2):249-52.
32. Majd Z, Haghpanah S, Ajami GH, et al. Serum ferritin levels correlation with heart and liver MRI and LIC in patients with transfusion-dependent thalassemia. Iran Red Crescent Med J. 2015;17(4):e24959.
33. Eghbali A, Taherahmadi H, Shahbazi M, et al. Association between serum ferritin level, cardiac and hepatic T2-star MRI in patients with major β-thalassemia. Iran J Ped Hematol Oncol. 2014;4(1):17-21.
| Files | ||
| Issue | Vol 17, No 4 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijhoscr.v17i4.13912 | |
| Keywords | ||
| Magnesium; Hypomagnesemia; Thalassemia major; T2*MRI; Liver; Heart | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ghasemi A, Ghaffari K, Hoseini F, Eghbali A, Sajadei N, Falahati V, Ghandi Y. Correlation of Magnesium Level with Cardiac and Hepatic Hemosiderosis Measured by T2*MRI Technique and Age in Patients with Thalassemia Major. Int J Hematol Oncol Stem Cell Res. 2023;17(4):224-230.
