The relation between serum ferritin level and echocardiographic findings in transfusion dependent thalassemic patients in Slemani City, Kurdistan Region of Iraq.

Saz Rasheed  Karim; Sana Dlawar  Jalal; Nawshirwan Gafoor  Rashid

doi:10.56056/amj.2024.260

Authors

Saz Rasheed Karim KHCMS-candidate, department of hematology, Hiwa Hemato-Oncology hospital, Slemani, Kurdistan Rigion, Iraq.
Sana Dlawar Jalal FIBMS, FRCpath-hematopathology. Professor in hematopathology., College of Medicine, University of Slemani, Kurdistan Region Iraq.
Nawshirwan Gafoor Rashid HDCH, FKHCMS, Clinical Hematologist. Hiwa Hemato-Oncology Hospital. College of Medicine, Kurdistan Region Iraq

DOI:

https://doi.org/10.56056/amj.2024.260

Keywords:

Echocardiography, Heart disease, Serum Ferritin level, Thalassemia

Abstract

Background and objectives: Thalassemia patients are at risk of iron overload. Those with transfusion-dependent thalassemia are more likely to experience cardiac problems because repeated blood transfusions cause iron accumulation in the cardiac myocyte. Thus, this study aims to determine the relationship between serum ferritin levels and echocardiographic findings in transfusion-dependent thalassemia patients.

Methods: This retrospective analytical cross-sectional study was conducted on 131 patients with transfusion-dependent thalassemia between 1^stDecember 2021 to 1^stJuly 2022 at the Center for Thalassemia and Congenital Blood Disorder, Slemani, Iraq. The participant’s information, including sociodemographic characteristics such as age, gender, body weight, height, hemoglobin level, serum ferritin, type and duration of chelation therapy, and echocardiographic findings, were collected from the hospital database using a questionnaire. Then, the correlation between serum ferritin levels and echocardiographic results was determined.

Results: The mean age of the patients was 21.24 ± 6.28 years, and most of them were males (55.7%), from the urban region (71%) and had an average body weight (68.7%). The mean serum ferritin level was 1876±1743.63 µg/L. The interpretation of the echocardiography results showed 38 patients (29%) had valvular heart diseases. Body mass index has a reverse linear relationship with ejection fraction(P=0.038) and a direct relationship with age(P<0.001). However, no significant association was found between echocardiographic findings and serum ferritin(P=0.83).

Conclusions: We found valvular heart diseases among the most common heart disorders in the patients. Suitable interventions and measures can significantly help manage the condition and reduce illness complications.

Downloads

Download data is not yet available.

References

Kremastinos DT, Farmakis D, Aessopos A, et al. ?-thalassemia cardiomyopathy: history, present considerations, and future perspectives. Circ Heart Fail. 2010;3(3):451-58.

Pennell DJ, Udelson JE, Arai AE, et al. Cardiovascular function and treatment in ?-thalassemia major: a consensus statement from the American Heart Association. Circ. 2013;128(3):281-308.

ALSaadi E. Disturbances of Lipid Profile, hemoglobin and Serum Ferritin Levels in Thalassemia Patients in Misan City, Amara, Iraq. J Med Chem Sci. 2022;5(5):779-86.

Sumneang N, Siri-Angkul N, Kumfu S, et al. The effects of iron overload on mitochondrial function, mitochondrial dynamics, and ferroptosis in cardiomyocytes. Arch Biochem Biophys. 2020; 680:108241.

Kremastinos D, Farmakis D. Iron overload cardiomyopathy in clinical practice. Circ. 2011;124(20):2253-63.

Ghanavat M, Haybar H, Pezeshki SMS, et al. Cardiomyopathy in thalassemia: quick review from cellular aspects to diagnosis and current treatments. Lab Med. 2020;51(2):143-50.

Rubis P. The diagnostic work up of genetic and inflammatory dilated cardiomyopathy. EJ Cardiol Pract. 2015;13(19):1-11.

Murphy CJ, Oudit GY. Iron-overload cardiomyopathy: pathophysiology, diagnosis, and treatment. J Card Fail. 2010;16(11):888-900.

Crawford B, Kasmidi M, Korompis F, et al. Factors influencing progress in establishing community-based marine protected areas in Indonesia. Coas Manage. 2006;34(1):39-64.

Ghandi Y, Eghbali A, Rafie F. Correlation between mean serum ferritin levels and atrial electrocardiographic markers in beta-thalassemia major. IJBC. 2018;10(3):76-81.

Wood JC. Cardiac complications in thalassemia major. Hemoglobin. 2009;33(sup1):S81-S86.

Khaled A, Ezzat DA, Salem HA, et al. Effective method of evaluating myocardial iron concentration in pediatric patients with thalassemia major. J Blood Med. 2019:227-33.

Shah F, Huey K, Deshpande S, et al. Relationship between Serum Ferritin and Outcomes in ?-Thalassemia: A Systematic Literature Review. J Clin Med. 2022;11(15):4448.

Heris HK, Nejati B, Rezazadeh K, et al. Evaluation of iron overload by cardiac and liver T2* in ?-thalassemia: Correlation with serum ferritin, heart function and liver enzymes. J Cardiovasc Thorac Res. 2021;13(1):54-60.

Ahmed RA, Salih AF, Omer SH, et al. Early Detection of Iron Overload Cardiomyopathy in Transfusion Dependent Thalassemia Patients in Sulaimaniyah City, Iraq. Ther Clin Risk Manag. 2022:259-71.

Esfahani H, Tanasan A, Rezanejad M, et al. Heart involvement in transfusion-dependent beta-thalassemia with conventional echocardiography. Caspian J Intern Med. 2021;12(3):243-48.

Fayed H, Mawgood E, Qubaisy H. Echocardiography in Transfusion Dependent Beta Thalassaemia Major Egyptian Children: Correlation with Thyroid Function Status and Ferritin Level. JCDR. 2018;12(4):1-7.

Hassan ZF, Shukur Alghanimi MK, Abbood A. Role of Tissue Doppler in Early Detection of Left Ventricular Dysfunction in Thalassemic Patients of Pediatric Age Group. Indian J Public Health Res Dev. 2020;11(4):1334-39.

Koohi F, Kazemi T, Miri-Moghaddam E. Cardiac complications and iron overload in beta thalassemia major patients—a systematic review and meta-analysis. Ann Hematol. 2019;98:1323-31.

Lidoriki I, Stavrou G, Schizas D, et al. Nutritional Status in a Sample of Patients With ?-Thalassemia Major. Cureus. 2022;14(8):e27985.

Ghandi Y, Habibi D, Eghbali A, et al. Influence of Average Annual Mean Serum Ferritin Levels on Left Ventricular Function in Patients With ? Thalassemia. Acta Med Iran. 2020;58(6):279-84.

Al-Numan A, Mohammed S, Al-Shamaa G. Screening of beta-thalassemia major patients below 18 years for acute cytomegalovirus infection by IGM serology in Mosul. Acta Med Mediterr. 2021;37:1009.

Suárez-Ortegón M-F, McLachlan S, Fernandez-Real J-M, et al. Serum ferritin and incident cardiometabolic diseases in Scottish adults. Cardiovas Diabetol. 2022;21(1):26.

Yuksel IO, Koklu E, Kurtoglu E, et al. The association between serum ferritin level, tissue Doppler echocardiography, cardiac T2* MRI, and heart rate recovery in patients with beta-thalassemia major. Acta Cardiol Sin. 2016;32(2):231-38.

Klip IT, Voors AA, Swinkels DW, et al. Serum ferritin and risk for new onset heart failure and cardiovascular events in the community. Eur J Heart Fail. 2017;19(3):348-56.

Wongtong N, Pornvipavee R, Ananwattanasuk T, et al. Relationship between Serum Ferritin Level and Left Ventricular Function in Thalassemia Patients. HTIJ. 2016;26(3):207-13.

Derchi G, Dessì C, Bina P, et al. Risk factors for heart disease in transfusion-dependent thalassemia: serum ferritin revisited. Intern Emerg Med. 2019;14:365-70.

Digra SK, Kumar D, Bhat S, et al. Echocardiographic Findings In Thalassemia Major Patients: An Experience From Jammu. JK Sci. 2019;21(1):8-10.

Abtahi F, Abdi A, Jamshidi S, et al. Global longitudinal strain as an Indicator of cardiac Iron overload in thalassemia patients. Cardiovasc Ultrasound. 2019;17:1-6.

Khalilian MR, Moghaddar R, Emami-Moghadam A, et al. Evaluation of the correlation between echocardiographic findings and serum ferritin in thalassemia major patients. Glob J Health Sci. 2016;8(12):190-96.

Chen MR, Ko HS, Chao TF, et al. Relation of myocardial systolic mechanics to serum ferritin level as a prognosticator in thalassemia patients undergoing repeated transfusion. Echocardiography. 2015;32(1):79-88.

Deraz SE, Abd El Naby SA, Mahmoud AA. Assessment of ventricular dysfunction in Egyptian children with Beta-thalassemia major. Hematol/Oncol Stem Cell Ther. 2021;14(3):206-13.

Casale M, Filosa A, Ragozzino A, et al. Long term improvement in cardiac magnetic resonance in thalassemia major patients treated with deferasirox extends to patients with abnormal baseline cardiac function. Am J Hematol. 2019;94(3):312-18.

Darvishi-Khezri H, Karami H, Naderisorki M, et al. Moderate to severe liver siderosis and raised AST are independent risk factors for vitamin D insufficiency in ?-thalassemia patients. Sci Rep. 2020;10(1):1-8.

Olivieri NF, Sabouhanian A, Gallie BL. Single-center retrospective study of the effectiveness and toxicity of the oral iron chelating drugs deferiprone and deferasirox. PLoS One. 2019;14(2):e0211942.

Sanpakit K, Narkbunnam N, Buaboonnam J, et al. Impact of splenectomy on outcomes of hematopoietic stem cell transplantation in pediatric patients with transfusion dependent thalassemia. Pediatr Blood Cancer. 2020;67(9):e28483.

Elalfy MS, Youssef OI, Deghedy MM, et al. Left Ventricular Structural and Functional Changes in Children With -Thalassemia and Sickle Cell Disease: Relationship to Sleep-disordered Breathing. J Pediatr Hematol/Oncol. 2018;40(3):171-77.

Noori NM, Yazdanparast A, Teimouri A. The Correlation of Ferritin and Leptin Serum Levels with Cardiac Involvement in Thalassemia Patients Compared to Controls. Int J Pediatr. 2018;6(5):7623-38.

Mohammed R, Manaa DSM, Rasha A, et al. Cardiac Iron Overload: Correlation between MRI T2* & Two Dimensional Strain Echocardiography in Children with b-Thalassemia Major. Med J Cairo Univ. 2018;86(June):1707-12.

Helmi N, Choudhry H, Qari M, et al. Association of serum asymmetric dimethyl-arginine and troponin I levels as a risk of myocardial infarction in thalassemia. Afr Health Sci. 2018;18(3):720-26.