Comparison of Right and Left Side Heart Functions in Patients with Thalassemia Major, Patients with Thalassemia Intermedia, and Control Group

Children and Adolescent Health Research Center, Aliebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran.
The journal of Tehran Heart Center 01/2013; 8(1):35-41.
Source: PubMed


Heart disease is the main cause of mortality and morbidity in patients with beta thalassemia, rendering its early diagnosis vital. We studied and compared echocardiographic findings in patients with beta thalassemia major, patients with beta thalassemia intermedia, and a control group.
Eighty asymptomatic patients with thalassemia major and 22 asymptomatic cases with thalassemia intermedia (8-25 years old) were selected from those referred to Ali Asghar Hospital (Zahedan-Iran) between June 2008 and June 2009. Additionally, 80 healthy individuals within the same age and sex groups were used as controls. All the individuals underwent echocardiography, the data of which were analyzed with the Student t-test.
The mean value of the pre-ejection period/ejection time ratio of the left ventricle during systole, the diameter of the posterior wall of the left ventricle during diastole, the left and right isovolumic relaxation times, and the right myocardial performance index in the patients with beta thalassemia major and intermedia increased significantly compared to those of the controls, but the other parameters were similar between the two patient groups. The mean values of the left and right pre-ejection periods, left ventricular end systolic dimension, and left isovolumic contraction time in the patients with thalassemia intermedia increased significantly compared to those of the controls. In the left side, myocardial performance index, left ventricular mass index, isovolumic contraction time, and deceleration time exhibited significant changes between the patients with thalassemia major and those with thalassemia intermedia, whereas all the echocardiographic parameters of the right side were similar between these two groups.
The results showed that the systolic and diastolic functions of the right and left sides of the heart would be impaired in patients with thalassemia major and thalassemia intermedia. Consequently, serial echocardiography is suggested in asymptomatic patients with beta thalassemia for an early diagnosis of heart dysfunction and proper treatment.

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Available from: Yalda Mirmesdagh, Jan 21, 2014
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    • "Finding of this study showed that in patients with thalassemia major and thalassemia intermedia, systolic and diastolic functions of the right and left hearts would be impaired. Therefore, serial echocardiography is recommended in asymptomatic patients with β-thalassemia for an early diagnosis of heart dysfunction (8). "
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    ABSTRACT: Background: In electrocardiography (ECG), QT is the interval between the onset of Q wave to the end of the T wave. This interval may be a sign of changes in the ventricular structure in hematologic disorders such as thalassemia major. Objectives: The main goal of this study was to compare the diagnostic value of corrected QT dispersion (QTcd) and QT dispersion (QTd) with left ventricular mass (LVM) and left ventricular mass index (LVMI) as well as to determine their sensitivity and specificity in early detection of the cardiac involvement in patients with beta-thalassemia major. Patients and Methods: In a case-control study, 60 patients older than ten years of age with thalassemia major who received regular blood transfusion and iron chelators were selected as the case group and were compared with 60 healthy age-and sex-matched subjects. All patients had myocardial performance index (MPI) of more than 0.5 and MPI for controls was less than 0.5. Echocardiography and ECG were performed for both groups and data were analyzed using appropriate statistical tests. Results: The mean age of cases and controls were 16 +/- 2.8 and 16.08 +/- 3.01 years, respectively. Male to female ratio was 33: 27 in case group and 31: 29 in the control group. LVMI in the case group was greater than control group. QTd and QTcd were larger in case group than in control group. The sensitivity and specificity of LVM, LVMI, QTd, and QTcd were as follows: 88.3%, 77.1%; 86.7%, 80%; 93.8%, 80%; and 91.7%, 86.7%, respectively. Conclusions: This study showed acceptable sensitivity and specificity of QTcd and QTd in comparison to LVMI; it seems that standard ECG can be used for early diagnosis of cardiac involvement in asymptomatic patients with thalassemia major.
    Full-text · Article · May 2014 · International journal of the Iranian Red Crescent Society
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    • "It is a disease of high prevalence in Mediterranean, Indian, North Chinese, and Pacific populations. Recently, the quantity and quality of the life of these patients have been significantly improved by regular transfusion and iron chelating therapy (1, 2). In another study, shahramian and et al showed that serum levels of leptin in major beta thalassemia reduces regardless of age and body mass (3). "
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    ABSTRACT: Beta-thalassemia is the most common hematology disease in human and leptin is one of the hormone that produce by adiposities cells. The purpose of this study was to investigate the relationship between serum leptin level and thyroid hormones in children with major beta-thalassemia. This descriptive-cross sectional study was performed on 90 children aged 6-16 years old with beta-thalassemia. Body Mass Index (BMI ) were meuseurd in all patients and then, after collecting the samples, leptin and thyroid hormones levels of the serum were measured in the patients with thalassemia via ELISA method. Then, all data was analyzed by Pearson correlation test, and x2 statistical tests and P < 0.05 was considered as a significant difference. The mean of body mass index and serum leptin level in the patients group was 16.58±2.43 and 1.521 ±2. 49, respectively. The mean serum levels of thyroxin (T4), triiodothyronine (T3), and thyroid- stimulating hormone (TSH) in patient's groups were7.94 ±3.56, 1.28 ± 0.46, and 2.85 ±3. 44, respectively. There was significant correlation between serum leptin levels and T4 in patients with major thalassemia; also there was no significant correlation between serum leptin level and T3and TSH. There was a significant correlation was between the leptin serum level and BMI in patients (P value=0.008). The results of this study demonstrated that in patients with major thalassemia, there was significant correlation between serum leptin level and thyroxin hormone. Leptin level has more relationship with thyroxin than thyroid- stimulating hormone.
    Full-text · Article · Oct 2013
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    • "Because of genetic predisposition, these patients have potential for early involvement; however, due to delay in the development of the symptoms and abnormality in the echocardiography, early diagnosis is impossible during the early processes (22). Therefore, we studied the relationship between troponin and ferritin serum levels for early diagnosis of cardiac involvement in patients with major beta thalassemia. "
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    ABSTRACT: Thalassemia is a hereditary hemoglobinopathy whose most common complication is cardiac involvement which ends up in these patients' death. Since troponin is a sensitive and specific marker for the detection of microinfarct, we studied the relationship between troponin and ferritin serum levels for early diagnosis of cardiac involvement in these patients. This case-control study was performed on 80 patients, including 40 patients with major thalassemia and normal echocardiography and 40 healthy volunteers ranging from 6 months to 16 years old. All the children were examined and the eligible children who were not infected with known heart disease, iron deficiency anemia, kidney disease, diabetes, fever, and systemic diseases were enrolled into the study after obtaining written informed consents from their parents. At 8:00 A.M. before breakfast, 5cc blood was drawn from these children. After collecting the samples, ferritin and troponin serum levels were evaluated using ELISA and electro- kymonolonsense methods, respectively. The gathered data were analyzed through the SPSS statistical software (v. 20) and T-test. Besides, P value<0.05 was considered as statistically significant. The study results revealed a significant difference between the two groups regarding the mean of the serum levels of troponin (P=0.045) and ferritin (P=0.001). In this study, no significant correlation was observed between serum troponin and ferritin levels and age and BMI in the two groups. Also, no significant relationship was found between serum troponin level and sex (P=0.264). In microinfarct, troponin increases independent of ferritin; therefore, it can be used for early detection of cardiac involvement in thalassemia patients to determine the sub-clinical effects.
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