Echocardiographic Characteristics Related to Chronic Iron Overload in Patient with Aplastic Anemia

BACKGROUND AND OBJECTIVES: In patients with aplastic anemia, chronic iron overload due to multiple blood transfusions, leads to secondary hemochromatosis. Cardiac involvement in hemochromatosis is the leading cause of death. The goal of this study was to find the echocardiographic characteristics of patients with aplastic anemia and chronic iron overload. SUBJECTS AND METHODS: Echocardiography was performed on 33 patients with aplastic anemia (age 33+/-10, M:F=14:19) and 15 controls (age 34+/-8, M:F=6:9). The regions of interest on digitalized 2-D images of the papillary muscle (PM) in the parasternal short-axis view and the interventricular septum (IVS) in the apical 4-chamber view were analyzed using histograms, which quantified the echoreflectiveness (256 gray scales; black=0, white=255) of the myocardium. The echocardiographic parameters of each group were compared, including wall thickness, chamber dimensions, systolic, diastolic function indexes and echoreflectiveness. The aplastic anemic patients were divided into two groups (22 with serum ferritin level> or =2,000 microgram/L vs. 11 with<2,000 microgram/L) and then compared. RESULTS: The right ventricular (RV) wall was thicker in the patients than the controls (4.1+/-1.2 mm vs. 2.6+/-0.5 mm, p<0.01). In the patients, the echoreflectiveness of the PM was typically higher than in the controls (gray scale, 173.9+/-40.9 vs. 80.72+/-34.1, p<0.01), with IVS showing higher reflectivity, but this was not statistically significant (80.4+/-16.6 vs. 75.2+/-13.7, p=0.41). Patients with a ferritin level (2,000 microgram/L had a thicker RV wall (4.4+/-1.2 mm vs. 3.3+/-0.6 mm, p=0.01) and larger left atrium (LA) dimension (38.1+/-1.4 mm vs. 32.2+/-1.9 mm, p=0.02) than those with a ferritin level<2,000 microgram/L. No considerable difference was found between the echoreflectiveness of each group. CONCLUSION: The echocardiographic findings, such as high echoreflectiveness in the PM, RV wall hypertrophy and LA dilation, might be characteristics suggestive of early myocardial changes due to chronic iron overload as a result of multiple transfusions.

Clinical Significance of B-Mode Ultrasound of Common Carotid Artery for Prediction of Severity of Coronary Artery Disease: Important Parameters on Hand Measurement

BACKGROUND AND OBJECTIVES: As a predictor of atherosclerosis, the intima-media thickness (IMT) of the common carotid artery (CCA) shows only a weak correlation with the extent of coronary artery disease (CAD). The purpose of this study was to evaluate the hand measured IMT value of the CCA as reliable and strong predictors of the severity of coronary artery atherosclerosis. SUBJECTS AND METHODS: We performed an ultrasonographic examination of the right CCA by using a 15 MHz linear array transducer in 268 patients (M: F=160: 108, mean age 61.2+/-10.2) who underwent coronary angiography to evaluate ischemic heart disease. The internal dimension, maximal IMT, irrespective of location and morphology (focal or diffuse), and the IMT of 6 more randomly selected points in the CCA were measured. We classified the plaques as type A (low or equal echo density compared with adventitia) or type B (higher echo density than adventitia). Modified Gensini scores were calculated, as a marker of the extent of CAD, and compared with the results of the IMT examination. RESULTS: Carotid plaques were detected in 156/268 (58%) patients. 119 and 37 patients were types A and B, respectively. The Gensini score was significantly higher in patients with type B (40.6+/-23.5) than type A plaques (29.3+/-21.7) (p=0.01). Modified Gensini score was correlated with age (r=0.22 p<0.001), mean IMT (r=0.178, p=0.004) and maximal IMT (r=0.296, p<0.001). After adjusting for age, the maximal IMT was the sole independent variable reflecting the severity of CAD (p=0.001). CONCLUSION: The maximal IMT, together with the type of CCA plaque morphology, provides more reliable information about the severity of CAD than the conventional mean IMT.