Evaluation of cardiovascular complications with 99mTc tetrofosmin gated myocardial perfusion scintigraphy in patients with thalassemia major.
OBJECTIVE
Iron overload limits the life expectancy of thalassaemic patients by causing cardiac toxicity. Iron also plays a catalytic role in the pathogenesis of atherosclerosis. The aim of this study was to evaluate the role of (99m)Tc Tetrofosmin gated myocardial perfusion scintigraphy (GMPS) in the detection of cardiac dysfunction in patients with thalassemia major.


METHODS
Forty two patients with homozygous beta-thalassemia were enrolled in the study. Myocardial perfusion and wall motion were analysed in all patients (mean age 17 +/- 5.28) and 34 age-matched controls using GMPS. Clinical data, liver function tests, hemoglobin, ferritin, low density lipoprotein (LDL) and cholesterol levels, and the total number and frequency of transfusions were collected from patient records.


RESULTS
97.6 % and 78.5 % of patients had normal myocardial perfusion and wall motion respectively. Nine out of 42 thalassaemic patients had abnormal left ventricular wall motion; half of these had septal hypokinesia. No significant correlation was found between the total number of transfusions, serum ferritin levels and left ventricular ejection fraction (p = 0.442 and p = 1.00, respectively). Echocardiography revealed systolic dysfunction in 5 out of 9 patients with wall motion abnormality. LDL was normal in 38 out of 42 patients and cholesterol levels were normal in 37 out of 42 patients.


CONCLUSIONS
Regional wall motion abnormalities can be seen in patients with thalassemia major. This early damage is frequently located in the septum and can be detected by GMPS. Serum ferritin levels and the number of blood transfusions are inadequate as predictors of myocardial dysfunction.
Department of Nuclear Medicine. Hacettepe University Faculty of Medicine. Ankara. Turkey. goncakara@yahoo.com
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Gedik
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Cağlar
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Unal
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Gümrük
D000293:Adolescent; D000328:Adult; D015913:Chelation Therapy; D002648:Child; D003131:Combined Modality Therapy; D003676:Deferoxamine / Q000627:therapeutic use; D005080:Exercise Test; D005260:Female; D005293:Ferritins / Q000097:blood; D015637:Gated Blood-Pool Imaging; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D019190:Iron Overload / Q000209:etiology; D008279:Magnetic Resonance Imaging; D008297:Male; D009038:Motion; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; D016037:Single-Blind Method; D065227:Transfusion Reaction; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology; D017086:beta-Thalassemia / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000628:therapy
D007502:Iron Chelating Agents; D009943:Organophosphorus Compounds; D015609:Organotechnetium Compounds; D019275:Radiopharmaceuticals; C078700:technetium tc-99m tetrofosmin; D005293:Ferritins; D003676:Deferoxamine