The correlation between cardiac T2*MRI and B-Type natriuretic peptides in patients with transfusion-dependent anemias and systemic iron overload: a systematic review and meta-analysis.

Objectives: Systemic iron overload in transfusion-dependent anemias leads to progressive myocardial iron accumulation, a major cause of morbidity and mortality. This study evaluated the relationship between cardiac T2* magnetic resonance imaging (MRI) values and natriuretic peptide levels in patients with systemic iron overload.

Methods: Cardiac T2* MRI magnetic resonance imaging (MRI) is the gold standard for assessing myocardial iron, but it is costly and not widely available. B-type natriuretic peptides (BNP and NT-proBNP), which reflect myocardial stress, may offer a practical biomarker alternative. This systematic review and meta-analysis evaluated the relationship between cardiac T2* MRI values and natriuretic peptide levels in patients with systemic iron overload. Nine studies involving 783 patients were included in the systematic review, and pooled analyses were performed using data from seven studies.

Results: Pooled data from seven studies showed a moderate inverse correlation between T2* values and natriuretic peptide levels (r = -0.30, 95% CI -0.51 to -0.06), indicating higher peptide levels with greater myocardial iron deposition. Patients with cardiac iron overload (T2* < 20 ms) had significantly higher peptide levels (standardized mean difference = -0.71, 95% CI -1.32 to -0.11), with pooled mean concentrations of 321.1 (95% CI 248.3-393.9) compared with 179.0 (95% CI 134.3-223.6) in those without cardiac iron overload (T2* > 20 ms).

Discussion: These findings suggest that natriuretic peptide levels reflect myocardial stress associated with cardiac iron burden and may provide clinically relevant information on myocardial iron overload.

Conclusion: Although natriuretic peptides cannot replace cardiac MRI, they may serve as accessible, low-cost adjunct biomarkers for screening, monitoring, and early warning of myocardial iron overload, particularly where MRI is limited. Further prospective studies are warranted to validate their role in longitudinal assessment and risk prediction.