Right ventricular function in patients with beta thalassemia: relation to serum ferritin level

Cardiac dysfunction is a major cause of death in patients with beta thalassemia. Right ventricular (RV) contribution to cardiac morbidity and mortality in these patients has been suggested. We aimed to assess RV function in beta thalassemia (beta-Th) patients and to detect the relation of serum ferritin level to RV dysfunction. Thirty young patients with beta-Th and 15 age-matched normal subjects (NL) were included. We measured RV end diastolic and end systolic diameters (RVEDD and RVESD), RV % fractional shortening (RVFS), RV pressure (RVP), lateral and septal tricuspid annular systolic and diastolic tissue Doppler velocities (Sa, Ea, Aa & Ea/Aa), and RV myocardial systolic and diastolic velocities at the basal RV segment (RVSm, RVEm, RVAm & RVEm/Am). Serum ferritin level was measured in beta-Th patients who were divided accordingly into two groups; G1 with serum ferritin > or =2,000 microg/L and G2 with serum ferritin < 2,000 microg/L. Compared to NL subjects, beta-Th patients had significantly higher RVEDD, RVESD & RVP, lower RVFS, higher Aa, and lower Ea/Aa at lateral and septal tricuspid annular sites, higher RVAm and lower RVEm/Am. Patients with higher serum ferritin level (G1) had higher RVP, higher RVEDD and RVESD, lower Sa at the lateral annular site and lower RVSm than patients in G2. High serum ferritin level was significantly associated with pulmonary hypertension. We concluded that patients with beta-Th have RV diastolic dysfunction, pulmonary hypertension is common, and the presence of RV systolic dysfunction in these patients is related to the higher level of serum ferritin.