1. Home
  2. Vol 53, No 3 (2021)
  3. Atmakusuma

Correlation of Serum Ferritin and Cardiac Iron Toxicity with Cardiac Function in Transfusion Dependent Beta-Thalassemia Major Patients

Tubagus Djumhana Atmakusuma, Rajesh Kalwani, Sally Aman Nasution, Cleopas Martin Rumende

Abstract


Background: Cardiac iron toxicity is a major cause of mortality in transfusion-dependent beta-thalassemia major patients. The main modality for detecting cardiac iron toxicity is MRI T2* with limited availability. This study aims to obtain iron toxicity profiles in transfusion-dependent beta-thalassemia patients; to see a correlation between iron toxicity and cardiac function. Methods: We conducted a cross-sectional study at the Adult Thalassemia Polyclinic of Cipto Mangunkusumo Hospital, Indonesia from December 2017 to March 2018. We performed the statistical analysis using Pearson/Spearman Test comparing MRI T2* values with ejection fraction and E/A ratio. Results: The median of 4-months mean of ferritin levels was 5130 ng/mL. The mean for cardiac T2* was 24.96 ms. Severe cardiac hemosiderosis (mean cardiac MRI T2* < 10 ms)  occurred in 11.3% of the subjects.  There was weak correlation between serum ferritin with cardiac iron toxicity (r=-0.272, p=0.032) and ejection fraction (r=-0.281, p=0.013). But, there was no correlation between cardiac iron toxicity with ejection fraction and E/A ratio. Conclusion: Serum ferritin correlated weakly with cardiac iron toxicity and cardiac systolic function. Meanwhile, there was no correlation between cardiac iron toxicity with cardiac systolic and diastolic function.

Keywords


cardiac iron toxicity; serum ferritin; systolic function; diastolic function; cardiac MRI T2*

References


Rund D, Rachmilewitz E. Beta-thalassemia. N Engl J Med. 2005;353(11):1135-46.

Derchi G, Formisano F, Balocco M, et al. Clinical management of cardiovascular complications in patients with thalassaemia major: a large observational multicenter study. Eur J Echocardiogr. 2011;12(3):242-6.

Borgna-Pignatti C, Rugolotto S, De Stefano P, et al. Survival and disease complications in thalassemia major. Ann N Y Acad Sci. 1998;850:227-31.

Pepe A, Meloni A, Rossi G, et al. Cardiac and hepatic iron and ejection fraction in thalassemia major: multicentre prospective comparison of combined deferiprone and deferoxamine therapy against deferiprone or deferoxamine monotherapy. J Cardiovasc Magn Reson. 2013;15(1):1.

Borgna‐Pignatti C, Cappellini M, De Stefano P, et al. Survival and complications in thalassemia. 2005;1054(1):40-7.

Ladis V, Chouliaras G, Berdousi H, Kanavakis E, Kattamis C. Longitudinal study of survival and causes of death in patients with thalassemia major in Greece. Ann N Y Acad Sci. 2005;1054:445-50.

Musallam KM, Cappellini MD, Wood JC, Taher AT. Iron overload in non-transfusion-dependent thalassemia: a clinical perspective. Blood Rev. 2012;26 Suppl 1:S16-9.

Pennell DJ, Udelson JE, Arai AE, et al. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation. 2013;128(3):281-308.

Eleftheriou A, Cannon L, Angastiniotis M. Thalassaemia prior and consequent to COVID-19 pandemic. The perspective of Thalassaemia International Federation (TIF). Thalassemia Reports. 2020;10(1).

Aessopos A, Kati M, Tsironi M. Congestive heart failure and treatment in thalassemia major. Hemoglobin. 2008;32(1-2):63-73.

Aessopos A, Berdoukas V, Tsironi MJEjoh. The heart in transfusion dependent homozygous thalassaemia today–prediction, prevention and management. 2008;80(2):93-106.

Gammella E, Recalcati S, Rybinska I, Buratti P, Cairo G. Iron-induced damage in cardiomyopathy: Oxidative-dependent and independent mechanisms. Oxidative Medicine and Cellular Longevity. 2015;2015:230182.

Nagueh SF, Appleton CP, Gillebert TC, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107-33.

Kremastinos DT, Tsiapras DP, Kostopoulou AG, Hamodraka ES, Chaidaroglou AS, Kapsali EDJEjohf. NT‐proBNP levels and diastolic dysfunction in β‐Thalassaemia major patients. 2007;9(5):531-6.

Moussavi F, Ghasabeh MA, Roodpeyma S, et al. Optimal method for early detection of cardiac disorders in thalassemia major patients: magnetic resonance imaging or echocardiography? Blood Res. 2014;49(3):182-6.

Amrita PNA, Bintoro SUY, Sedana MP, et al. Serum ferritin level affects T lymphocyte CD4, CD8, and CD4/CD8 ratio in transfusion-dependent beta-thalassemia. Drug Invention Today. 2020;13(6):887-92.

Yuksel IO, Koklu E, Kurtoglu E, et al. The association between serum Ferritin level, tissue doppler echocardiography, cardiac T2* MRI, and heart rate recovery in patients with beta thalassemia major. Acta Cardiol Sin. 2016;32(2):231-8.

Chinprateep B, Ratanasit N, Kaolawanich Y, et al. Prevalence of left ventricular diastolic dysfunction by cardiac magnetic resonance imaging in thalassemia major patients with normal left ventricular systolic function. BMC Cardiovasc Disord. 2019;19(1):245.

Patton N, Brown G, Leung M, et al. Observational study of iron overload as assessed by magnetic resonance imaging in an adult population of transfusion‐dependent patients with β thalassaemia: significant association between low cardiac T2*< 10 ms and cardiac events. 2010;40(6):419-26.

Akpinar O, Acartürk E, Kanadaşi M, Ünsal Ç, Başlamişli FJAc. Tissue doppler imaging and NT-proBNP levels show the early impairment of ventricular function in patients with ß-thalassaemia major. 2007;62(3):225-31.

Djer MM, Anggriawan SL, Gatot D, Amalia P, Sastroasmoro S, Widjaja P. Correlation between T2* cardiovascular magnetic resonance with left ventricular function and mass in adolescent and adult major thalassemia patients with iron overload. Acta Med Indones. 2013;45(4):295-301.

Kremastinos DT, Farmakis D. Iron overload cardiomyopathy in clinical practice. Circulation. 2011;124(20):2253-63.

Aessopos A, Giakoumis A, Fragodimitri C, et al. Correlation of echocardiography parameters with cardiac magnetic resonance imaging in transfusion‐dependent thalassaemia major. 2007;78(1):58-65.

Nisli K, Taner Y, Naci O, et al. Electrocardiographic markers for the early detection of cardiac disease in patients with beta-thalassemia major. J Pediatr (Rio J). 2010;86(2):159-62.


Full Text: PDF

Refbacks

  • There are currently no refbacks.