Cardiovascular complications are the most common cause of death
among thalassemia patients in Thailand. In this study, we evaluated the prevalence
of cardiac iron overload, cardiovascular complications and the associated
risk factors. The information obtained will serve as a guidance for surveillance,
prevention and early treatment of the complications. We conducted a cross sectional
study of Thai patients with thalassemia attending Chiang Mai University
Hospital, Thailand. Cardiac T2* magnetic resonance imaging (CMR T2*) was used
to evaluate the myocardial iron deposition and echocardiography was used to
evaluate the cardiac function and to identify pulmonary hypertension. Ninety-one
patients were included in the study; 64% females with a median age of 31 (16-75)
years. Of the total study subjects, 49% had homozygous â thalassemia, 32% had
â thalassemia/Hb E disease, and 19% had Hb H disease. Half the participants
were transfusion-dependent and 84% had received iron chelation. The CMR T2*
showed cardiac iron overload in 10 patients (11%). The maximum ferritin level
in the previous 3 years was higher among the patients with cardiac iron overload
(6,310 ng/ml) than among the patients without cardiac iron overload (3,352 ng/ml)
(p=0.001). Twenty-one patients (23%) had cardiovascular complications. Cardiomyopathy
was seen in 8% of patients [17% in patients with transfusion-dependent
thalassemia (TDT) and none in patients with non-transfusion-dependent thalassemia
(NTDT)] and pulmonary hypertension in 15% of patients (14% in patients
with TDT and 16% in patients with NTDT). TDT and cardiac iron overload were
significantly associated with cardiomyopathy. No risk factors were found to be significantly
associated with pulmonary hypertension. In summary, cardiac iron overload
and cardiomyopathy are important complications in TDT while pulmonary
hypertension is seen in both TDT and NTDT. Iron chelation and monitoring of
serum ferritin level will prevent cardiac iron overload and cardiomyopathy. Interval
monitoring with echocardiography will help with early identification of
the cardiac complications.
Adolescent Adult