Cardiovascular involvement in patients with beta-thalassemia major without cardiac iron overload.
BACKGROUND
Cardiovascular complications are common in beta-thalassemia major (beta-TM), mainly attributed to increased cardiac iron depositions. Early cardiovascular involvement in patients without cardiac symptoms and without cardiac iron overload has not been adequately investigated.


METHODS
Twenty six patients (11 males) with beta-TM, on chelation therapy, age 23+/-4 years without cardiac iron overload (measured by magnetic resonance imaging), and 30 age and gender matched healthy controls were included in the study. Carotid-femoral and carotid-radial pulse wave velocity (PWVc-f and PWVc-r) and augmentation index (AI) were measured by SphygmoCor device; carotid intima-media thickness; left ventricular (LV) dimensions and function; left atrial (LA) volume and function were assessed by echocardiography.


RESULTS
Patients with beta-TM had higher PWVc-f (8.4+/-1.4 vs 7.2+/-1.1 m/s, p=0.002) and augmentation index (21.7+/-10.9 vs 14.7+/-9.7%, p=0.04) indicating decreased aortic elastic properties; greater LV mass index (72.0+/-13.3 vs 63.8+/-11.5 g/m(2), p=0.04) and greater LA volumes. Multivariate logistic regression analysis revealed that higher PWVc-f was independently associated with higher LV mass [OR 1.74 95%CI (1.09-2.88), p=0.026]; and greater LA dimensions [OR 1.68 95%CI (1.04-2.72), p=0.035].


CONCLUSIONS
In the absence of cardiac iron overload, asymptomatic patients with beta-TM demonstrated aortic stiffening associated with increased LV mass and LA enlargement. These alterations may represent signs of early cardiovascular involvement.
Cardiology Division, Democritus University of Thrace, Alexandroupolis, Greece. dstakos@med.duth.gr
D A
DA
Stakos
D
D
Margaritis
D N
DN
Tziakas
I
I
Kotsianidis
G K
GK
Chalikias
K
K
Tsatalas
G
G
Bourikas
H
H
Boudoulas
D000328:Adult; D001011:Aorta / Q000000981:diagnostic imaging / Q000473:pathology; D001018:Aortic Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D001783:Blood Flow Velocity; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D004452:Echocardiography; D004548:Elasticity; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology; D019190:Iron Overload; D016014:Linear Models; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D015999:Multivariate Analysis; D011673:Pulsatile Flow; D017534:Radial Artery / Q000000981:diagnostic imaging / Q000473:pathology; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications*