Myocardial Iron Deficiency Quantification and Effective Cardiac Iron Management Strategy Exploration evaluated by Cardiac T2* Mapping in End-Stage Renal Disease Patients.

Purpose: To explore myocardial iron content using Cardiac T2* Mapping in dialysis patients undergoing oral iron therapy or intravenous iron supplements compared to healthy controls.

Methods: Fifty-nine dialysis patients, including 30 peritoneal dialysis (PD) patients who underwent oral iron therapy, 29 hemodialysis (HD) dialysis patients who underwent intravenous iron supplements, and 30 healthy controls were included in the study. Cardiac MRI, including cine, T2 stir, and T2* mapping, was conducted at 3.0T. Quantitive T2* mapping, Cine imaging analysis was performed by two radiologists using cvi42.

Results: The global cardiac T2* value was higher in dialysis patients than in healthy controls (27.1 ± 6.29 ms versus 24.6 ± 3.60 ms, p< 0.05). The global cardiac T2* value of PD patients was higher than that of HD patients (28.5 ± 4.30 ms versus 25.x7 ± 3.54 ms, p< 0.05). The anteroseptal cardiac T2* value was higher in PD patients than in healthy controls (32.0 ± 4.49 ms versus 27.8 ± 4.02 ms, p< 0.05). The global T2* value negatively correlated with left ventricular ejection fraction (LVEF), peak radial strain, circumferential strain, and longitudinal strain.

Conclusion: Our study confirmed that PD patients have myocardial iron deficiency despite undergoing oral iron therapy compared to HD patients who received intravenous iron treatments. And the Cardiac T2* value was found to be an independent risk factor and predictor of LVEF and left ventricular altered mechanics. Intravenous iron supplements may be an effective cardiac iron management strategy in patients with HD-dependent end-stage renal disease.