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The effect of iron overload in the hearts of patients with beta-thalassemia
S V Brili1, A I Tzonou, S S Castelanos
1University of Athens, Cardiology Department, Hippokration Hospital, Greece.
Insights
Beta-thalassemia patients show increased iron in the heart, impacting left atrial size and function. Elevated serum ferritin levels are linked to these cardiac changes before systolic dysfunction appears.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Beta-thalassemia is associated with cardiac iron deposition, leading to fibrosis and dysfunction.
- Early detection of cardiac impact is crucial for managing beta-thalassemia complications.
Purpose of the Study:
- To investigate the clinical effect of cardiac iron loading in beta-thalassemia patients.
- To assess iron's impact before the onset of depressed systolic function.
Main Methods:
- Echocardiography and measurement of serum ferritin, atrial natriuretic peptide (ANP), left atrial diameter (LAD), and mitral inflow velocities (E/A ratio).
- Study included 35 beta-thalassemia patients (major and intermedia types) and 11 controls.
Main Results:
- Patients with beta-thalassemia exhibited increased LAD and ANP levels compared to controls.
- Higher serum ferritin levels correlated with increased LAD and E/A ratio.
- Multivariate analysis confirmed serum ferritin's influence on LAD and E/A ratio.
Conclusions:
- Elevated serum ferritin levels in beta-thalassemia patients impact left atrial size and E/A ratio.
- ANP secretion is consequently affected by these iron-related cardiac changes.
- These findings highlight the subclinical cardiac effects of iron overload in beta-thalassemia.
Background And Hypothesis:
An important complication of beta-thalassemia is iron deposition in cardiac tissues resulting in fibrosis and dysfunction. Our aim was the investigation of the possible clinical effect of iron loading in the heart of patients with beta-thalassemia prior to the appearance of symptoms of depressed systolic function.
Methods:
Thirty-five patients with beta-thalassemia, of whom 24 had the major type (Group 1) and 11 had the intermedia type (Group 2) were studied. Eleven age- and gender-matched controls were also studied (Group 3). All patients were evaluated echocardiographically and were shown to have normal left ventricular systolic function and dimensions. Serum ferritin, atrial natriuretic peptide (ANP), left atrial diameter (LAD), peak early mitral inflow velocity (E), peak late mitral inflow velocity (A), E/A ratio, deceleration time of the mitral inflow E wave (DT), and isovolumic relaxation time (IVRT) were measured.
Results:
Univariate analysis showed that both groups of patients had similarly increased LAD and ANP plasma levels. Group 1 had a higher E/A ratio (2.27 +/- 0.88) SS than Group 2 (1.69 +/- 0.47, p = 0.05) and Group 3 (1.50 +/- 0.38, p = 0.01). Serum ferritin was significantly higher in Group 1 (3.526 +/- 0.352) than in Group 2 (2.808 +/- 0.288, p < 10(-5) and Group 3 (2.139 +/- 0.124, p < 10(-5). Multivariate analysis showed that ANP is a factor that is affected by the LAD and E/A ratio and that serum ferritin levels affect the LAD and E/A ratio.
Conclusions:
Although LAD and ANP levels are increased in patients with beta-thalassemia, the increased serum ferritin levels of patients seem to affect left atrial size and E/A ratio. ANP secretion is consecutively affected by these factors.