Performance and Correlations of Myocardial Contraction Fraction Derived From MRI in Transfusion‐Dependent Thalassemia Patients

ABSTRACT Background Myocardial contraction fraction (MCF) is a promising volumetric index of myocardial function. Purpose To evaluate the association of MRI‐derived MCF with demographic characteristics, clinical data, MRI findings, and the history of heart failure in patients with transfusion‐dependent thalassemia (TDT). Study Type Retrospective. Subjects 1154 TDT patients (52.9% female, 37.46 ± 10.67 years) enrolled in the Extension–Myocardial Iron Overload in Thalassemia project and 167 healthy subjects (54.5% female, 36.33 ± 15.78 years). Field Strength/Sequence 1.5 T/cine imaging for assessment of left ventricular (LV) function parameters, gradient‐echo T2* technique for myocardial iron overload (MIO) assessment, late gadolinium enhancement (LGE) imaging for detection of replacement myocardial fibrosis. Assessment MCF was calculated as LV stroke volume divided by LV myocardial volume. Statistical Tests Independent‐samples t ‐test, Wilcoxon signed‐rank test, and chi‐squared test for comparison between groups; analysis of covariance; Pearson's or Spearman's correlations; univariable and stepwise multivariable linear regression analyses; receiver operating characteristic curve analysis for assessment of diagnostic efficiency and DeLong's test for area under the curves (AUCs) comparison. Statistical significance was defined as p < 0.05. Results Healthy subjects and TDT patients showed comparable MCF values (99.5% ± 15.0% vs. 102.7% ± 29.7%, p = 0.820). In TDT, MCF was significantly lower in males compared to females (98.4% ± 27.1% vs. 106.6% ± 31.3%) and in patients with diabetes (96.8% ± 29.7% vs. 103.7% ± 29.1%). MCF significantly decreased with age ( R = −0.066). MCF was significantly correlated with global heart T2* values ( R = 0.075), and patients with MIO (T2* < 20 ms) had a significantly lower MCF compared to those without (96.3% ± 22.0% vs. 103.3% ± 30.2%). MCF had a significant inverse correlation with the number of LGE‐positive segments ( R = −0.314). MCF demonstrated a diagnostic performance comparable to that of global heart T2* values in distinguishing between TDT patients with and without a history of heart failure (AUC 0.63 vs. 0.58, p = 0.401 for the difference). The LV ejection fraction did not significantly differentiate patients based on heart failure history (AUC = 0.55, p = 0.223). Data Conclusion In patients with TDT, MCF was significantly correlated with MIO and LGE extent. Additionally, patients with a history of heart failure had significantly impaired MCF. Evidence Level 4. Technical Efficacy Stage 2.