Analysis of the influencing factors related to liver and cardiac iron overload in MDS patients detected by MRI in the real world

Figures & data

Table 1. Patient characteristics.

Patient’s characteristics	Blood transfusion group (n = 92)	Non-transfusion group (n = 13)
Male/female	61/31	8/5
Median age (m) (range)	55.58 (20–82)	62.77 (48–80)
WHO classification, n (%)
MDS-SLD	1 (1%)	0 (0%)
MDS-MLD	46 (50%)	8 (61.5%)
MDS-RS	9 (9. 8%)	3 (23.1%)
MDS-EB-1	20 (21.7%)	1 (7.7%)
MDS-EB-2	8 (8.7%)	1 (7.7%)
tAML	8 (8.7%)	0 (0%)
IPSS-R score, n (%)
≤1.5	6 (6.5%)	1 (7.7%)
1.5 < and ≤ 3	26 (28.3%)	5 (38.5%)
3 < and ≤ 4.5	39 (42.4%)	6 (46.2%)
4.5 < and ≤ 6	17 (18.5%)	1 (7.7%)
6<	4 (4.3%)	0 (0%)
Cytogenetic score, n (%)
0 (very low)	7 (7.6%)	0 (0%)
1 (low)	68 (73.9%)	9 (69.2%)
2 (intermediate)	12 (13.0%)	4 (30.8%)
3 (high)	3 (3.3%)	0 (0%)
4 (very high)	2 (2.2%)	0 (0%)
SF (m) (range)	2166.65 (359–9304)	994 (511–1642)
ASF (m) (range)	1969.23 (229–9304)	964.5 (511–1642)
TS (m) (range)	80.06 (17.5–100)	73.46 (47.49–99)
Liver T2*(m) (range)	2.59 (2.4–18.2)	4.22 (1.2–14.4)
6.3 ms<(n, %)	5 (5.4%)	1 (7.7%)
1.4 < and ≤ 6.3 ms (n, %)	54 (58.7%)	11 (84.6%)
≤1.4 ms (n, %)	33 (35.9%)	1 (7.7%)
Cardiac T2*(m) (range)	22.77 (6.4–47.07)	20.96 (13.8–36)
20 ms< (n, %)	56 (60.9%)	7 (53.8%)
8 < and ≤ 20 ms (n, %)	32 (34.8%)	6 (46.2%)
≤8 ms (n, %)	4 (4.3%)	0 (0%)
EPO (m) (range)	5479.76 (47–24353)	935.92 (39–2650)

Note: MDS (myelodysplastic syndrome). WHO (World Health Organization). The risk classification is determined according to the numerical rating system at the time of initial diagnosis. MDS-SLD (single lineage dysplasia), MDS-MLD (multi lineage dysplasia), MDS-RS (ring sideroblasts), MDS-EB (excess blasts), tAML (MDS transformed acute myeloid leukemia). IPSS-R (Revised International prognostic scoring system). ASF (adjusted serum ferritin). TS (transferrin saturation). Among 92 cases of RBC transfusion, 56 cases are complicated with transfusion dependence. Transfusion-dependent:at least 4 units of RBC with 8 weeks for hemoglobin<6g/dL.

Figure 1. (a1) Liver T2* is negatively correlated with ASF (r = −0.285, p = 0.003). (a2) Cardiac T2* is negatively correlated with ASF (r = −0.267, p = 0.006). (a3) There is no significant correlation between liver T2* and cardiac T2* (r = −0.012, p = 0.903). (b1) There are significant differences in ASF between groups 1 and 2 (647.8 ± 314.2 vs 1397.2 ± 461.8, p < 0.05), between groups 2 and 3 (1397.2 ± 461.8 vs 2806.9 ± 1037.3, p < 0.05), and between groups 1 and 3 (647.8 ± 314.2 vs 2806.9 ± 1037.3, p < 0.05). (b2) There are significant differences in ASF between groups 1 and 2 (1613.7 ± 504.8 vs 2136.5 ± 493.9, p < 0.05), between groups 2 and 3 (2136.5 ± 493.9 vs 5372.0 ± 2985.4, p < 0.05), and between groups 1 and 3(1613.7 ± 504.8 vs 5372.0 ± 2985.4, p < 0.05). (b3) Cardiac T2*corresponds to ASF all higher in the normal group, mild to moderate group and severe group than those in the liver T2* group (1613.7 ± 504.8 vs 647.8 ± 314.2, p < 0.05; 2136.5 ± 493.9 vs1397.2 ± 461.8, p < 0.05; 5372.0 ± 2985.4 vs 2806.9 ± 1037.3, p < 0.05).

Figure 2. (a1) In liver T2*, the expression of EPO in group 2 is significantly higher than that in group 1 (4032.24 ± 206.27 vs 365.83 ± 137.36, p < 0.05), and the expression of EPO in group 3 is significantly higher than that in group 2 (7327.03 ± 983.88 vs 4032.24 ± 206.27, p < 0.05).(a2) The expression of EPO in the RBC transfusion group is significantly higher than that in the no RBC transfusion group (4512.64 ± 2869.43 vs 935.92 ± 419.35, p < 0.05).(b1) There is significant correlation between ASF and EPO (r = 0.288, p = 0.003) in all 105 MDS patients. (b2) There is significant correlation between liver T2* and EPO in all patients (r = −0.287, p = 0.003). (b3) There is no significant correlation between cardiac T2* and EPO in all patients (r = 0.027, p = 0.788). (c1) There is no significant correlation between ASF and EPO in 13 no RBC transfusion MDS patients (r = 0.164, p = 0.593). (c2) There is no significant correlation between liver T2* and EPO in no RBC transfusion patients (r = 0.184, p = 0.547). (c3) There is no significant correlation between cardiac T2* and EPO in no RBC transfusion patients (r = 0.090, p = 0.771).

Figure 3. (a1) The total content of blood transfusion is significantly positive correlated with the levels of ASF (r = 0.619, p < 0.001). (a2) The total content of blood transfusion is significantly negatively correlated with liver T2* (r = −0.208, p = 0.033). (a3) The total content of blood transfusion is significantly negatively correlated with the values of cardiac T2* (r = −0.259, p = 0.008). (b) In terms of ASF levels, there are significant differences between groups 1 and 2 (978 ± 330 vs1628 ± 997, p < 0.05), between groups 2 and 3 (1628 ± 997 vs 4284 ± 2380, p < 0.05) and between groups 1 and 3 (978 ± 330 vs 4284 ± 2380, p < 0.05). In the values of liver T2*, there are significant differences between groups 1 and 2 (4.02 ± 3.19 vs 2.72 ± 2.66, p < 0.05), between groups 2 and 3 (2.72 ± 2.66 vs 1.82 ± 1.75, p < 0.05), and between groups 1 and 3 (4.02 ± 3.19 vs 1.82 ± 1.75, p < 0.05). In terms of values of cardiac T2*, there are no significant differences between groups 1 and 2 (20.91 ± 5.81 vs 23.37 ± 7.23, p > 0.05), between groups 2 and 3 (23.37 ± 7.23 vs 19.00 ± 6.28, p > 0.05) and between groups 1 and 3 (20.91 ± 5.81 vs 19.00 ± 6.28, p > 0.05). (c1) There are significant differences between the non-transfusion group and blood transfusion group in the values of liver T2* (4.22 ± 1.11 vs 1.74 ± 0.60, p < 0.05), and in cardiac T2* (20.96 ± 15.16 vs 14.26 ± 11.55, p < 0.05). (c2) There are significant differences between the non-transfusion group and blood transfusion group in the levels of ASF (964.46 ± 638.09 vs 2836.50 ± 900.20, p < 0.05).

Figure 4. (a1) There is no significant correlation between liver T2* and ALT (r = −0.038, p = 0.699). (a2) No significant correlation between liver T2* and TBL (r = −0.187, p = 0.058). (a3) No significant correlation between liver T2* and r-GT (r = −0.153, p = 0.126). (a4) No significant correlation between liver T2* and LDH (r = 0.069, p = 0.500). (b1) There is no significant correlation between cardiac T2* and LDH(r = −0.079, p = 0.442). (b2) No significant correlation between cardiac T2* and LVEF (r = 0.057, p = 0.639). (b3) No significant correlation between cardiac T2* and E/A (r = 0.204, p = 0.092). (b4) No significant correlation between cardiac T2* and CKMB (r = −0.143, p = 0.218). (b5) There is significant correlation between cardiac T2 * and BNP (r = −0.246, p = 0.048). (b6) Grouping according to the values of cardiac T2*, the BNP in severe group is significantly higher than that in the mild to moderate group (1613.73 ± 312.38 vs 289.15 ± 173.85, p < 0.05) and that in the normal group (1613.73 ± 312.38 vs 268.95 ± 59.70, p < 0.05), and there is no significant difference between the mild to moderate group and normal group (289.15 ± 173.85 vs 268.95 ± 59.70, p > 0.05). Note: alanine aminotransferase (ALT), total bilirubin (TBL), glutamyl transferase (r-GT), lactate dehydrogenase (LDH), left ventricular ejection fraction (LVEF), the ration of early stage peak flow rate and late stage peak flow rate (E/A), creatine kinase isoenzymes (CKMB) and brain natriuretic peptide (BNP).

Figure 5. (a1) No correlation is found between liver T2* and IPSS score (r = −0.111, p = 0.362). (a2) No correlation is found between liver T2* and IPSS-R score (r = −0.081, p = 0.413). (a3) No correlation is found between liver T2* and WPSS score (r = −0.117, p = 0.304). (b1) No correlation is found between cardiac T2* and IPSS score (r = −0.159, p = 0.190). (b2) No correlation is found between cardiac T2* and IPSS-R score (r = −0.019, p = 0.845). (b3) No correlation is found between cardiac T2* and WPSS score (r = −0.036, p = 0.750).

Table 2. The change in ASF, liver T2*, cardiac T2*, EPO and BNP before and after iron chelation therapy (ICT).

	ASF(ng/ml)	Liver T2*	Cardiac T2*	EPO (mIU/ml)	BNP (ng/L)
Before ICT	2113.10 ± 1259.34	1.84 ± 1.01	21.79 ± 5.32	6855.15 ± 4076.71	283.32 ± 141.83
After ICT	1225.95 ± 598.70	2.55 ± 1.03	21.66 ± 6.42	3913.25 ± 3310.32	295.74 ± 159.23
p value	0.007	0.034	0. 943	0.017	0.796

Note: Adjusted ferritin (ASF). Erythropoietin (EPO), brain natriuretic peptide (BNP). A total of 35 patients have received ICT and 20 of them as a subgroup have received MRI examination before and after ICT. The subgroup all has received ICT for more than four courses. Among them, 18 have completed eight courses, 15 have completed 10 courses and 12 have completed 16 courses. The median duration ICT time is 226 days (range: 140–468 days).

Figure 6. (a1) No correlation is found between groups 1 and 2 (1712.27 ± 1693.58 vs 2048.20 ± 1289.89, p = 0.271), between groups 1 and 3 (1712.27 ± 1693.58 vs 1232.67 ± 703.79, p = 0.223), and between groups 2 and 3 (2048.20 ± 1289.89 vs 1232.67 ± 703.79, p = 0.038) in the levels of ASF. (a2) No significant differences between groups 1 and 2 (3.095 ± 3.347 vs 2.321 ± 1.724, p = 0.153), between groups 1 and 3 (3.095 ± 3.347 vs 2.220 ± 0.726, p = 0.141), and between groups 2 and 3 (2.321 ± 1.724 vs 2.220 ± 0.726, p = 0.809). (b1) There are no significant differences between age < 60 year and age > 60 year group in the levels of ASF (1861.79 ± 1531.84 vs 1824.69 ± 1424.81, p = 0.898). (b2) No significant differences between these two age groups in the values of liver T2*(2.66 ± 2.12 vs 2.96 ± 2.53, p = 0.606). (b3) No significant difference between these two age groups (24.44 ± 7.22 vs 20.29 ± 6.22, p = 0.002) in the values of cardiac T2*.