title: Relation between NT-proBNP levels, iron overload, and early stage of myocardial dysfunction in β-thalassemia major patients.
abstract: BACKGROUND
  Heart failure (HF) secondary to myocardial iron loading remains the leading cause of death in β-thalassemia major (β-TM) patients. The early diagnosis and treatment of HF in these patients is related to survival. We aimed to evaluate myocardial performance using conventional and tissue Doppler echocardiography and its relation to plasma NT-proBNP levels and iron overload indices in β-TM patients with preserved systolic function.
  
  
  METHODS
  The study population included 49 β-TM patients (24.0 ± 4.2 years) and 48 age-matched healthy controls. Doppler-echocardiographic study was performed and blood samples for NT-proBNP measurements were drawn on the third day following blood transfusion. Patients were divided as group-1, without diastolic dysfunction: E/E' ratio < 9 and group-2, with suspected diastolic dysfunction: E/E' ratio ≥ 9.
  
  
  RESULTS
  NT-proBNP levels and E/E' ratio were increased in patients compared with controls (P < 0.001 and P < 0.001) but did not correlate with each other. A strong positive correlation was detected between NT-proBNP levels and mean ferritin levels in β-TM patients (r(s) = 0.939; P < 0.001). Median NT-proBNP levels were significantly higher in group-1 in comparison to controls [51.2 (41.51-113.5) vs 30.1 (17.97-68.16) ng/mL, P < 0.01]. NT-proBNP levels were also increased in group-2 in comparison to group-1 but this increase was not statistically significant.
  
  
  CONCLUSIONS
  NT-proBNP secretion begins in the early phase of the disease before the increase in diastolic pressure becomes overt. While there was a strong correlation between the plasma NT-proBNP levels and iron overload, there was no correlation between NT-proBNP levels and diastolic dysfunction parameters in patients in the third decade of life.
authors: Department of Pediatric Hematology, Ege University, Izmir, Turkey. can.balkan@ege.edu.tr
authors: Can
authors: C
authors: Balkan
authors: Selcen Yakar
authors: SY
authors: Tuluce
authors: Gunes
authors: G
authors: Basol
authors: Kamil
authors: K
authors: Tuluce
authors: Yılmaz
authors: Y
authors: Ay
authors: Deniz Yilmaz
authors: DY
authors: Karapinar
authors: Cemil
authors: C
authors: Gurgun
authors: Oya
authors: O
authors: Bayindir
authors: Kaan
authors: K
authors: Kavakli
mesh_terms: D015415:Biomarkers / Q000097:blood; D015897:Comorbidity; D004452:Echocardiography / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D019190:Iron Overload / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D014421:Turkey / Q000453:epidemiology; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D055815:Young Adult; D017086:beta-Thalassemia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain