Cardiac status in well-treated patients with thalassemia major.
OBJECTIVE
To assess cardiac status in a large group of patients with thalassemia major who had been treated in a standard way since their early infancy with intensive transfusions and deferoxamine chelation therapy and who had good compliance with this regimen.


RESULTS
We assessed clinically and echocardiographically 202 thalassemia major patients aged 27.3 +/- 6.3 yr and 75 age and sex-matched healthy controls. Overt cardiac disease was encountered in 14 patients (6.9%), including 5 (2.5%) with congestive heart failure, aged 26-37 yr, and 9 with systolic left ventricular (LV) dysfunction, aged 23-37 yr. Ten patients (5.0%) had a history of pericarditis. Left atrial and LV diameters, LV mass and cardiac output were significantly higher in patients than in controls, while peripheral resistance and LV afterload were significantly lower. Relative LV wall thickness did not differ between patients and controls, but it was significantly lower in patients with overt cardiac disease compared to those without (P < 0.05). Restrictive LV filling was observed in 37.6% of patients and was significantly more frequent in cases with overt cardiac disease (P < 0.01). Pulmonary hypertension was practically absent. Hematological parameters and pulmonary artery pressure levels were not independently associated with the presence of overt cardiac disease.


CONCLUSIONS
Strict lifelong adherence to the standard transfusion and deferoxamine therapy reduces considerably the occurrence of heart failure, LV dysfunction and pericarditis, prevents early heart failure and pulmonary hypertension, but does not eliminate completely cardiac disease in patients with thalassemia major.
Cardiac Outpatient Clinic for Hemoglobinopathies, First Department of Internal Medicine, University of Athens Medical School, Laiko Hospital, Athens, Greece. dfarm1@panafonet.gr
Athanasios
A
Aessopos
Dimitrios
D
Farmakis
Antonia
A
Hatziliami
Christina
C
Fragodimitri
Fotis
F
Karabatsos
Jacqueline
J
Joussef
Eftichia
E
Mitilineou
Evanthia
E
Diamanti-Kandaraki
John
J
Meletis
Markisia
M
Karagiorga
D000293:Adolescent; D000328:Adult; D001803:Blood Transfusion; D002302:Cardiac Output; D002648:Child; D003676:Deferoxamine / Q000627:therapeutic use; D004452:Echocardiography; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006325:Heart Atria / Q000473:pathology; D006331:Heart Diseases / Q000453:epidemiology* / Q000517:prevention & control; D006333:Heart Failure / Q000453:epidemiology; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology; D007502:Iron Chelating Agents / Q000627:therapeutic use; D008297:Male; D010349:Patient Compliance; D010493:Pericarditis / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology; D017086:beta-Thalassemia / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*
D007502:Iron Chelating Agents; D003676:Deferoxamine