Cardiovascular involvement in patients with β-thalassemia major without cardiac iron overload

BackgroundCardiovascular complications are common in beta-thalassemia major (β-TM), mainly attributed to increased cardiac iron depositions. Early cardiovascular involvement in patients without cardiac symptoms and without cardiac iron overload has not been adequately investigated.MethodsTwenty six patients (11 males) with β-TM, on chelation therapy, age 23 ± 4 years without cardiac iron overload (measured by magnetic resonance imaging), and 30 age and gender matched healthy controls were included in the study. Carotid–femoral and carotid–radial pulse wave velocity (PWVc-f and PWVc-r) and augmentation index (AI) were measured by SphygmoCor device; carotid intima-media thickness; left ventricular (LV) dimensions and function; left atrial (LA) volume and function were assessed by echocardiography.ResultsPatients with β-TM had higher PWVc-f (8.4 ± 1.4 vs 7.2 ± 1.1 m/s, p = 0.002) and augmentation index (21.7 ± 10.9 vs 14.7 ± 9.7%, p = 0.04) indicating decreased aortic elastic properties; greater LV mass index (72.0 ± 13.3 vs 63.8 ± 11.5 g/m2, p = 0.04) and greater LA volumes. Multivariate logistic regression analysis revealed that higher PWVc-f was independently associated with higher LV mass [OR 1.74 95%CI (1.09–2.88), p = 0.026]; and greater LA dimensions [OR 1.68 95%CI (1.04–2.72), p = 0.035].ConclusionsIn the absence of cardiac iron overload, asymptomatic patients with β-TM demonstrated aortic stiffening associated with increased LV mass and LA enlargement. These alterations may represent signs of early cardiovascular involvement.