Early Detection of Iron Overload Cardiomyopathy in Transfusion Dependent Thalassemia Patients in Sulaimaniyah City, Iraq

Rana Adnan Ahmed; Aso Faeq Salih; Shirwan Hamasalih Omer; Heshu Sulaiman Rahman; Luqman Khalid Rasool

doi:10.2147/TCRM.S354574

Early Detection of Iron Overload Cardiomyopathy in Transfusion Dependent Thalassemia Patients in Sulaimaniyah City, Iraq

Ther Clin Risk Manag. 2022 Mar 22:18:259-271. doi: 10.2147/TCRM.S354574. eCollection 2022.

Authors

Rana Adnan Ahmed¹, Aso Faeq Salih², Shirwan Hamasalih Omer¹, Heshu Sulaiman Rahman^{1

3}, Luqman Khalid Rasool⁴

Affiliations

¹ Department of Physiology, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq.
² Department of Pediatrics, College of Medicine, University of Sulaimani, Sulaimaniyah, Republic of Iraq.
³ Department of Medical Laboratory Sciences, Komar University of Science and Technology, Sulaimaniyah, Republic of Iraq.
⁴ Hiwa Hematology/Oncology Hospital and Sulaimaniyah Thalassemia and Congenital Blood Disorders Center, Sulaimaniyah, Republic of Iraq.

Abstract

Background: Lifelong blood transfusion is recommended for patients with transfusion-dependent thalassemia (TDT) that lead to iron overload and results in cardiomyopathy (CM).

Aim: To assess the accuracy of several electrocardiographic (ECG) data in patients at high risk of arrhythmia, early detection of structural and functional changes in left atrium and ventricle using ECG and echocardiography (two dimensional, M-mode echocardiography along with Doppler studies), and to observe the correlations between plasma B-type atrial natriuretic peptide (BNP)/serum ferritin and ECG with Doppler as well as echocardiographic changes in patients with TDT.

Methods: The current prospective case-control study included 75 TDT patients and 74 control subjects with the mean age of 9.55 and 9.93 years, respectively. Participants were assessed for the socio-demographic, physical examinations, serum ferritin, plasma BNP, ECG, 2D echocardiography, and tissue/pulse wave Doppler.

Results: The mean of serum ferritin and plasma BNP were significantly (p<0.001) higher in the cases (1475.19 ng/mL and 47.63 pg/mL, respectively) than controls (41.3 ng/mL and BNP 23.37 pg/mL, respectively). ECG findings showed significant higher P-wave dispersion, QRS duration, QT duration and dispersion, and JTc dispersion in cases than controls. Echocardiography findings revealed diastolic dysfunction with preserved ejection fraction (EF) in thalassemia cases, as well as significant higher left ventricular (LV) mass, LV internal diameters during systole and diastole (LVIDs and d) and LV posterior wall thickness during diastole (LVPWd) in cases than controls (p<0.05). Also, a significant (p<0.05) correlation between BNP and QT dispersion was found in patients.

Conclusion: These findings suggest the usefulness of ECG, 2D echocardiographic, Doppler studies and plasma BNP, with no significant beneficial effect of serum ferritin level in detecting early cardiac changes in patients with TDT.

Keywords: blood transfusion; case-control study; hereditary disease; iron overload; thalassemia complications.

Grants and funding

No funding was received.