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. 2009 Feb 3;20(6):541–546. doi: 10.1002/clc.4960200607

The effect of iron overload in the hearts of patients with beta‐thalassemia

Stella V Brili 1,✉, Stamatis S Castelanos 1, Constadina J Aggeli 1, Costas A Tentolouris 1, Christos E Pitsavos 1, Pavlos K Toutouzas 1, Anastasia I Tzonou 2
PMCID: PMC6655738  PMID: 9181265

Abstract

Background and hypothesis: An important complication of beta‐thalassemia is iron deposition in cardiac tissues resulting in fibrosis and dysfunction. Our aim was the investigation of the possible clinical effect of iron loading in the heart of patients with beta‐thalassemia prior to the appearance of symptoms of depressed systolic function.

Methods: Thirty‐five patients with beta‐thalassemia, of whom 24 had the major type (Group 1) and 11 had the intermedia type (Group 2) were studied. Eleven age‐ and gender‐matched controls were also studied (Group 3). All patients were evaluated echocardiographically and were shown to have normal left ventricular systolic function and dimensions. Serum ferritin, atrial natriuretic peptide (ANP), left atrial diameter (LAD), peak early mitral inflow velocity (E), peak late mitral inflow velocity (A), E/A ratio, deceleration time of the mitral inflow E wave (DT), and isovolumic relaxation time (IVRT) were measured.

Results: Univariate analysis showed that both groups of patients had similarly increased LAD and ANP plasma levels. Group 1 had a higher E/A ratio (2.27 ± 0.88) SS than Group 2 (1.69 ± 0.47, p = 0.05) and Group 3(1.50 ± 0.38, p = 0.01). Serum ferritin was significantly higher in Group 1 (3.526 ± 0.352) than in Group 2 (2.808 ± 0.288, p < 10–5) and Group 3 (2.139 ± 0.124, p<10–5). Multivariate analysis showed that ANP is a factor that is affected by the LAD and E/A ratio and that serum ferritin levels affect the LAD and E/A ratio.

Conclusions: Although LAD and ANP levels are increased in patients with beta‐thalassemia, the increased serum ferritin levels of patients seem to affect left atrial size and E/A ratio. ANP secretion is consecutively affected by these factors.

Keywords: beta‐thalassemia, atrial natriuretic peptide, ferritin

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References

  • 1. Weatherall DJ, Clegg JB: The Thalassaemia Syndromes. 3rd Edition Oxford: Blackwell Scientific Publications, 1981. [Google Scholar]
  • 2. Modell B, Berdoukas V: The Clinical Approach to Thalassaemia. London: Grune & Stratton, 1984. [Google Scholar]
  • 3. Piomelli S, Karpatkin MH, Arzanian M, Zamani M, Becker MH, Geneiser N, Danoff S, Kuhns WJ: Hypertransfusion regimen in patients with Cooley's anemia. Ann NY Acad Sci 1974; 232: 186–192 [DOI] [PubMed] [Google Scholar]
  • 4. Schellhammer PF, Engle MA, Hagstrom JW: Histochemical studies of the myocardium and conduction system in acquired iron‐storage disease. Circulation 1967; 35: 631–635 [DOI] [PubMed] [Google Scholar]
  • 5. Buja LM, Roberts WC: Iron in the heart: Etiology and clinical significance. Am J Med 1971; 51: 209–221 [DOI] [PubMed] [Google Scholar]
  • 6. Engle MA: Cardiac involvement in Cooley's anemia. Ann NY Acad Sci 1965; 119: 694–702 [DOI] [PubMed] [Google Scholar]
  • 7. Lewis BS, Rachmilewitz EA, Amitai N, Halon DA, Gotsman MS: Left ventricular function in b̃‐thalassemia and the effect of multiple transfusions. Am Heart J 1978; 96: 636–645 [DOI] [PubMed] [Google Scholar]
  • 8. Henry WL, Nienhuis AW, Wiener M, Miller DR, Canale VC, Piomelli S: Echocardiographic abnormalities in patients with transfusion‐dependent anemia and secondary myocardial iron deposition. Am J Med 1978; 64: 547–555 [DOI] [PubMed] [Google Scholar]
  • 9. Finch SC, Finch CA: Idiopathic hemochromatosis, an iron storage disease. Medicine 1955; 34: 381–430 [DOI] [PubMed] [Google Scholar]
  • 10. Engle MA, Erlandson M, Smith CH: Late cardiac complications of chronic severe refractory anemia with hemochromatosis. Circulation 1964; 30: 698–704 [DOI] [PubMed] [Google Scholar]
  • 11. Sapoznikov D, Lewis N, Rachmilewitz EA: Left ventricular filling and emptying patterns in anemia due to beta‐thalassemia: A computer‐assisted echocardiographic study. Cardiology 1982; 69: 276–282 [DOI] [PubMed] [Google Scholar]
  • 12. Lau KC, Li AMC, Hui PW, Yeung CY: Left ventricular function in b̃‐thalassemia major. Arch Dis Child 1989; 64: 1046–1051 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13. de Bold AJ: ANF: A hormone produced by the heart. Science 1985; 230: 767–770 [DOI] [PubMed] [Google Scholar]
  • 14. Hedner T, Hedner J, Anderson A, Persson B, Petterson A: ANP‐A cardiac hormone and a putative central neurotransmitter. Eur Heart J 1987; 8 (suppl II ):87–98 [DOI] [PubMed] [Google Scholar]
  • 15. Cantin M, Genest J: The heart and the atrial natriuretic factor. Endocrine Rev 1985; 6: 107–127 [DOI] [PubMed] [Google Scholar]
  • 16. Gunther S, Steinman R, Lehmann M, Sowers J: Kinetics of endogenous atrial natriuretic peptide release and metabolism in humans (abstr). J Am Coll Cardiol 1987; 9: 119A 3098816 [Google Scholar]
  • 17. Yamaji T, Hirai N, Ishibashi M, Takaku F, Yanaihara T, Nakayama T: Atrial natriuretic peptide in umbilical cord blood: Evidence for a circulating hormone in the human fetus. J Clin Endocrinol Metab 1986; 63: 1414–1417 [DOI] [PubMed] [Google Scholar]
  • 18. Weil J, Bidlingmaier F, Dohlemann C, Kuhnle U, Strom T, Lang R: Comparison of plasma atrial natriuretic peptide levels in healthy children from birth to adolescence and in children with cardiac disease. Pediatr Res 1986; 20: 1328–1331 [DOI] [PubMed] [Google Scholar]
  • 19. Ackermann DM, Edwards BS, Wold LE, Burnette JC: Atrial natriuretic peptide localization in the human heart. J Am Med Assoc 1986; 256: 1048 [PubMed] [Google Scholar]
  • 20. Rodeheffer RJ, Tanaka I, Imada T, Hollister AS, Robertson D, Inagami T: Atrial pressure and secretion of atrial natriuretic factor into the human central circulation. J Am Coll Cardiol 1986; 8: 8–26 [DOI] [PubMed] [Google Scholar]
  • 21. Obata K, Yasue H, Horio Y, Naomi S, Umeda T, Sato T, Miyata A, Kangawa K, Matsuo H: Increase of human atrial natriuretic polypeptide in response to cardiac pacing. Am Heart J 1987; 113: 845–849 [DOI] [PubMed] [Google Scholar]
  • 22. Ogihara T, Shima J, Hara H, Kumahara Y, Kangawa K, Matsuo H: Changes in human plasma atrial natriuretic polypeptide concentration in normal subjects during passive leg raising and whole body tilting. Clin Sci 1986; 71: 147–150 [DOI] [PubMed] [Google Scholar]
  • 23. Raine AG, Erne P, Burgisser E, Muller F, Bolli P, Burkart F, Buhler F: Atrial natriuretic peptide and atrial pressure in patients with congestive heart failure. N Engl J Med 1986; 315: 533–537 [DOI] [PubMed] [Google Scholar]
  • 24. Haas M, Dietz M, Fischer T: Role of right and left atrial dimensions for release of atrial natriuretic peptide in left sided valvular heart disease and idiopathic dilated cardiomyopathy. Am J Cardiol 1988; 62: 764–770 [DOI] [PubMed] [Google Scholar]
  • 25. Pegram BL, Trippodo NC, Natsume T, Kardon MB, Frohlich ED, Cole FE, MacPhee A: Hemodynamic effects of atrial natriuretic hormone. Federation Proc 1986; 45: 2382–2386 [PubMed] [Google Scholar]
  • 26. Jacobs A, Miller F, Worwood M, Beamish M, Wardrop C: Ferritin in the serum of normal subjects and patients with iron deficiency and iron overload. Br Med J 1972; 4: 206–208 (1972). [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 27. Armitage P, Berry G: Statistical Methods in Medical Research. Oxford: Blackwell Scientific Publications, 1987. [Google Scholar]
  • 28. Zimmerman RS, Gharib H, Zimmerman D, Heublein D, Burnett C Jr: Atrial natriuretic peptide in hypothyroidism. J Clin Endocrinol Metab 1987; 64: 353–355 [DOI] [PubMed] [Google Scholar]
  • 29. Lang RE, Unger T, Ganten D, Weil J, Bidlingmaier F, Dohlemann D: Atrial natriuretic peptide concentrations in plasma of children with congenital heart and pulmonary diseases. Br Med J 1985; 291: 1241 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 30. Ross R, Daniels S, Dolan L, Young C, Meyer R: Determinants of plasma atrial natriuretic factor concentrations in congenital heart disease. Am J Cardiol 1988; 62: 785–788 [DOI] [PubMed] [Google Scholar]
  • 31. Appleton CP, Hatle LK, Popp RL: Relation of transmittal flow velocity patterns to left ventricular diastolic function: New insights from a combined hemodynamic and Doppler echocardiographic study. J Am Coll Cardiol 1988; 12: 426–440 [DOI] [PubMed] [Google Scholar]
  • 32. Choong CY, Abascal VM, Thomas JD, Guerreco JL, McGlew S, Weyman AE: Combined influence of ventricular loading and relaxation on the transmitral flow velocity profile in dogs measured by Doppler echocardiography. Circulation 1988; 78: 672–683 [DOI] [PubMed] [Google Scholar]
  • 33. Kremastinos D, Tsiapras DP, Tsetsos GA, Rentoukas EI, Vretou HP, Toutouzas PK: Left ventricular diastolic Doppler characteristics in b̃‐thalassemia major. Circulation 1993; 88 (3): 1127–1135 [DOI] [PubMed] [Google Scholar]
  • 34. Derchi G, Bellone P, Luca Forni G, Lupi G, Jappelli S, Randazzo M, Zino V, Vecchio C: Cardiac involvement in thalassaemia major: Altered atrial natriuretic peptide levels in asymptomatic patients. Eur Heart J 1992; 13: 1368–1372 [DOI] [PubMed] [Google Scholar]
  • 35. Gennes de L, Delarue J, DeVericourt R: Le syndrome endocrino‐hepato‐cardiaque. Presse Med 1936; 1: 377 [Google Scholar]

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