Influence of Average Annual Mean Serum Ferritin Levels on Left Ventricular Function in Patients With β Thalassemia
Cardiac complications are the most important cause of mortality and morbidity in Beta-Thalassemia Major (B-TM). The aim of our study was to determine the influence of Average Annual Mean Serum Ferritin (AAMSF) levels on cardiac function in patients suffering from B-TM. In this cross-sectional study, 50 patients of 5-15 years with B-TM were enrolled in the absence of clinical signs and symptoms of cardiac dysfunction. Left ventricular function was studied by using tissue Doppler image (TDI), pulse wave Doppler (PWD). AAMSF level was measured for 12 months. Patient groups were subdivided into two groups, group A with AAMSF level below 1000 ng/ml and group with B with AAMSF level above 1000 ng/ml. The Case group included 24(48%) males and 26(52%) females which were compared with 50 healthy subjects composed of 27(54%) males and 23 (46%) females (control group). The AAMSF Levels were 1054.60±687.95 ng/ml. By using PDW, in patients with AAMSF below 1000 ng/ml, The Parameters of the E, A, E/A E-DT had no significant difference with health groups (P=0.808, P=0.820, P=0.231 and P=0.061, respectively). No significant difference was revealed in parameters of E’, IVCT and ET in patients with AAMSF below 1000 ng/ml by using TDI in comparison to control (P=0.155, P=0.683, P=0.222, respectively).however, other TDI indexes including A’, E’/A’, IVRT, S,’ LVMPI, E/E’ had a significant difference with health group (P=0.014, P=0.041, P=0.045, P=0.002, P=0.021, and P=0.002, respectively). At patients with above AAMSF 1000 ng/mL, both PDW and TDI parameters had significant differences with the health group. There was no correlation among AAMSF levels and PWD or TDI indexes. The evidence from this study suggests that subclinical systolic and diastolic LV dysfunction has happened with AAMSF level above 1000 ng/ml, and according to our result, TDI is found more useful than PWD for subclinical cardiac evaluation.
2- 9. Aessopos A, Farmakis D, Hatziliami A, Fragodimitri C, Karabatsos F, Joussef J et al. Cardiac status in well-treated patients with thalassemia major. Eur J Haematol 2004; 73: 359–66.
3- Chrysohoou C, Greenberg M, Pitsavos C, Panagiotakos DB, Ladis V,Barbetseas J et al. Diastolic function in young patients with beta-thalassemia major: an echocardiographic study. Echocardiography 2006; 23:38–44.
4. Atig M, Bana M, Ahmed US, Bano S, Yousuf M, Fadoo Z et al. Cardiac disease in beta-thalassemia major: is it reversible? Singapore Med J 2006;47:693–6.
5. Ocal B, Oguz D, Karademir S, Birgen D, Yüksek N, Ertem U,et al. Myocardial performance index combining systolic and diastolic myocardial performance in doxorubicin-treated patients and its correlation to conventional echo/Doppler indices. Pediatr Cardiol. 2002; 23(5):522-7.
6. Eghbali A MD, Taherahmadi H, Bagheri B, Nikanjam S, Ebrahimi L. Association between serum ferritin level and diastolic cardiac function in patients with major β-thalassemia. Iranian Journal of Pediatric Hematology Oncology.
7. Kyriacou K, Michaelides Y, Senkus R, Simamonian K, Pavlides N, Antoniades L, Zambartas C. Ultrastructural pathology of the heart in patients with beta-thalassaemia major. UltrastructPathol. 2000 Mar-Apr;24(2):75-81.
8. P. Roeser, J. W. Halliday, D. J. Sizemore, A. Nikles, D. Willgoss; Serum Ferritin in Ascorbic Acid Deficiency. British Journal of Haematology.1980 july 45( 3):459–466.
9. Shahmohammadi P. N. Davari, Y. Aarabi , M. Meraji ,A. Tabib, H. Mortezaeian. Echocardiographic Assessment of Cardiac Involvement in Patients with Thalassemia Major: Evidence of Abnormal Relaxation Pattern of the Left Ventricle in Children andYoung Patients. Archive of SID 2006;7:13-19.
10. Modell B, Berdoukas V, The clinical approach to thalassemia. 1984, New York: Grune and Stratton. p. 171.
11. K. Papadopoulou-Legbelo, S.G. Varlamis, M. Athanassiou-Metaxa, S. Karamperis, A. Malaka-Zafiriou. Full resting echocardiographic study of left ventricle in children with b-thalassemia major.2009, 2-3 : 132-138
12. Hahalis G, Manolis AS, Apostolopoulos D, Alexopoulos D, Vagenakis AG, Zoumbos NC. Right ventricular cardiomyopathy in beta-thalassemia major. Eur Heart J 2002; 23: 147-56.
13. Öcal B, Oğuz O, Karademir S, Birgen D, Yüksek N, Ertem U, et al. Myocardial performance index combining systolic and diastolic myocardial performance in doxorubicin-treated patients and its correlation to conventional echo/Doppler indices. Pediatr Cardiol 2002; 23: 522-7.
14. Gharzuddine WS, Kazma HK, Nuwayhid IA, Bitar FF, Koussa SF, Moukarbel GV, et al. Doppler characterization of left ventricular diastolic function in beta-thalassaemia major. Evidence for an early stage of impaired relaxation. Eur J Echocardiogr 2002; 3: 47-51.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.