title: Evaluation of carotid artery dynamics & correlation with cardiac & hepatic iron in β-thalassaemia patients.
abstract: OBJECTIVE
  Early atherosclerosis and vascular complication have been described in thalassaemia patients. There is lack of data or guidelines regarding monitoring of vascular health in thalassaemia. This study was conducted to compare carotid artery structural and functional indices such as carotid artery intima-media thickness (CIMT), stiffness index (SI) and Young's elastic modulus (YEM) in β-thalassemia patients with age and sex matched controls, and to correlate these parameters with serum ferritin, cardiac iron, and hepatic iron.
  
  
  METHODS
  This cross-sectional study included 53 β-thalassaemia patients receiving regular blood transfusions. Carotid artery indices such as CIMT, SI, and YEM were calculated by duplex ultrasound and colour Doppler. Serum ferritin levels were measured by chemiluminescence. Cardiac and hepatic iron estimation were done using MRI T2* sequences analyzed by a special thalassaemia software.
  
  
  RESULTS
  Mean CIMT of cases and controls were 0.48 ± 0.04 and 0.44±0.02 mm, respectively and these were significantly different (P<0.001). Similarly significant differences were noted in SI and YEM of cases (2.45±0.79 and 96.12±34.85, respectively) as compared to controls (1.98±0.54 and 68.60±24.29, respectively) (p<0.001). There was significant inverse correlation between stiffness index and cardiac iron overload assessed by MRI cardiac T2* (p=0.03). Mean SI and YEM of cases were (2.1736 ± 0.2986 and 107.3± 41.6, respectively) significantly higher among non-splenectomized patients compared to splenectomized patients (2.0136 ± 0.263 and 86.9 ± 25.2, respectively) (p<0.05).
  
  
  CONCLUSIONS
  CIMT and arterial stiffness indices were significantly increased in β-thalassaemia patients compared to controls which was indicative of early atherogenic changes. This study supports the hypothesis that iron overload is a risk factor for early atherosclerosis and cardiovascular disease.
authors.affiliation: Department of Pediatrics, Nanavati Hospital, Mumbai, India.
authors.forename: Rashid H
authors.initials: RH
authors.lastname: Merchant
authors.affiliation: Department of Pediatrics, Nanavati Hospital, Mumbai, India.
authors.forename: Someshwar
authors.initials: S
authors.lastname: Chate
authors.affiliation: Department of Pediatrics, Nanavati Hospital, Mumbai, India.
authors.forename: Javed
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Dr DY Patil Medical College, Navi Mumbai, India.
authors.forename: Noor
authors.initials: N
authors.lastname: Ahmad
authors.affiliation: Department of Radiology, Nanavati Hospital, Mumbai, India.
authors.forename: Alka
authors.initials: A
authors.lastname: Karnik
authors.affiliation: Department of Radiology, SRL Jankharia Imaging, Mumbai, India.
authors.forename: Bhavin
authors.initials: B
authors.lastname: Jankaria
mesh_terms: D000293:Adolescent; D000328:Adult; D050197:Atherosclerosis / Q000150:complications / Q000000981:diagnostic imaging / Q000378:metabolism / Q000503:physiopathology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000473:pathology; D059168:Carotid Intima-Media Thickness; D005260:Female; D005293:Ferritins / Q000097:blood; D006801:Humans; D007501:Iron / Q000378:metabolism*; D008099:Liver / Q000378:metabolism; D008279:Magnetic Resonance Imaging; D008297:Male; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D012307:Risk Factors; D014463:Ultrasonography; D059289:Vascular Stiffness / Q000502:physiology; D055815:Young Adult; D017086:beta-Thalassemia / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D005293:Ferritins; D007501:Iron