ABSTRACT
PURPOSE: To evaluate the survival of patients with beta thalassemia and heart failure who were treated with iron chelation therapy. SUBJECTS AND METHODS: Fifty-two consecutive patients with beta thalassemia and heart failure were followed in a prospective 5-year study. All patients underwent a full clinical examination with chest radiograph, electrocardiogram, and echocardiographic investigation performed at 6-month intervals or when a new symptom developed. RESULTS: Of the 52 patients (mean [+/- SD] age, 24 +/- 5 years), 25 (48%) survived 5 years after the onset of heart failure. Forty-three patients had left-sided heart failure, and 9 had right-sided heart failure. Those with left-sided heart failure were younger at presentation with heart failure (22 +/- 4 years vs. 31 +/- 6 years; P <0.001), had lower ejection fractions (36% +/- 9% vs. 64% +/- 10%; P <0.001), and had a lower mean serum ferritin level (3355 +/- 1241 ng/mL vs. 6,397 +/- 1,613 ng/mL; P <0.001). CONCLUSION: The 5-year survival rate in patients with beta thalassemia with heart failure was greater than previously reported. There are clinical characteristics that may make patients more likely to develop left- or right-sided heart failure.
Subject(s)
Heart Failure/etiology , Heart Failure/mortality , beta-Thalassemia/complications , beta-Thalassemia/mortality , Adult , Antihypertensive Agents/therapeutic use , Diuretics/therapeutic use , Echocardiography, Doppler , Electrocardiography, Ambulatory , Enalapril/therapeutic use , Female , Follow-Up Studies , Furosemide/therapeutic use , Heart Failure/diagnosis , Heart Failure/drug therapy , Humans , Iron Chelating Agents/therapeutic use , Male , Prospective Studies , Statistics, Nonparametric , Survival Analysis , Treatment Outcome , beta-Thalassemia/drug therapySubject(s)
Atrial Fibrillation/physiopathology , Echocardiography, Transesophageal , Pulmonary Veins/physiopathology , Atrial Fibrillation/diagnostic imaging , Blood Flow Velocity , Blood Pressure/physiology , Echocardiography, Doppler , Electric Countershock , Electrocardiography , Female , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Mitral Valve/physiopathology , Phonocardiography , Pulmonary Veins/diagnostic imaging , Regional Blood Flow , Systole/physiologyABSTRACT
BACKGROUND: Diastolic left ventricular function expressed by diastolic Doppler characteristics of the left ventricle has never been properly investigated. METHODS AND RESULTS: Left ventricular inflow and pulmonary vein flow patterns were assessed by Doppler echocardiography in 88 beta-thalassemia major patients with normal left ventricular systolic function; 34 were young (age, 15.1 +/- 3.2 years) and 54 were adults (age, 25.1 +/- 3.6 years). The findings were compared with those obtained from 22 young (age, 13.8 +/- 2.4 years) and 24 adult (age, 25.3 +/- 4.1 years) normal individuals. In both groups of patients, peak flow velocities in early (E) and late (A) diastole were higher than in the control subjects (young E: P < .01; adult E: P < .001; young A: P < .05; adult A: P < .05), whereas no difference was found in the E/A ratio, deceleration time, or isovolumic relaxation time. Pulmonary vein systolic (S) and diastolic (D) velocities were also higher in beta-thalassemia major patients compared with the control subjects (young S: P < .05; adult S: P < .05; young D: P < .05; adult D: P < .05). Restrictive left ventricular abnormalities were only found in 7 patients who were among the oldest beta-thalassemia major population of the adult group (P < .01) with highly elevated mean serum ferritin. In comparison to the remaining adult patients, interventricular septum and left ventricular posterior wall thickness were increased (P < .01 and P < .01, respectively). The left atrium and right ventricle were dilated (P < .05 and P < .01, respectively). CONCLUSIONS: Doppler diastolic indexes in beta-thalassemia major patients with normal left ventricular systolic function are similar to those seen in conditions with an increased preload, probably because of chronic anemia. Only severe iron loading and deposition in the myocardium leads to the restrictive abnormalities of left ventricular filling.
