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Kahnoji M, Bitaraf S, Soltani N, Esmaeili-Nadimi H. The Prevalence of Pulmonary Arterial Hypertension in Patients with Beta Thalassemia Major. Indian J Hematol Blood Transfus 2024; 40:74-77. [PMID: 38312173 PMCID: PMC10831030 DOI: 10.1007/s12288-023-01678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 06/23/2023] [Indexed: 02/06/2024] Open
Abstract
Pulmonary arterial hypertension (PAH) remains a concern in patients with Beta thalassemia major (TM). However, this study aims to investigate the prevalence of PAH in TM patients in Kerman City placed in the south of Iran. In this cross-sectional study on 271 IranianBeta-thalassemia patients (mean age 19.8 ± 7.9 in the range 10-60), Age, sex, weekly deferral taking, the number of blood transfusion in a month, and last echocardiography report data was gathered from every patient's file. SPSS for Windows (version 21) was used for analysis. According to the results, the prevalence of PAH was 10.3% (28 patients). PAH had significant associations with weekly deferral consumption (P = 0.028), ferritin serum level (P = 0.001), and ejection fraction (EF) (P = 0.001). PAH is positively associated with deferral consumption and is negatively associated with EF (respectively, P = 0.031, P = 0.001). It is very important to consider prevention and treatment for decreasing the mortality and morbidity of PAH patients in health planning and policy.
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Affiliation(s)
- Masoumeh Kahnoji
- Cardiovascular Research Center, Institute of Basic and Clinical Physiology Science, Kerman University of Medical Science, Kerman, Iran
| | - Saeid Bitaraf
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
| | - Narjes Soltani
- Physiology-Pharmacology Research Center, Research Institute of Basic Medical Sciences, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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Kalamara TV, Dodos K, Vlachaki E. Splenectomy is significantly associated with thrombosis but not with pulmonary hypertension in patients with transfusion-dependent thalassemia: a meta-analysis of observational studies. Front Med (Lausanne) 2023; 10:1259785. [PMID: 37886361 PMCID: PMC10598854 DOI: 10.3389/fmed.2023.1259785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Thromboembolism (TE) and pulmonary hypertension (PH) constitute frequently occurring complications in patients with transfusion-dependent thalassemia and have been associated with splenectomy in different studies. Nevertheless, the size of the possible association varies greatly in literature. Herein, we sought to provide pooled effect estimates regarding the impact of splenectomy on TE and PH in transfusion dependent thalassemia (TDT) by retrieving relevant, available studies. Methods We systematically searched articles published in PubMed, Cochrane library, Scopus and gray literature from inception until the 30th of May, 2023. Pooled estimates in terms of odds ratios (OR) and 95% confidence intervals (CI) were calculated according to outcome measures. Risk of bias and quality of studies were evaluated. Results Regarding TE, 4 studies were selected for meta-analysis and the pooled data demonstrated that splenectomy was significantly associated with this outcome in TDT patients [OR = 4.08, 95% CI (1.03, 16.11), p = 0.04]. On the other hand, we pooled data from seven investigating PH, and, interestingly, the quantitative analysis revealed no association between splenectomy and PH [OR = 1.76, 95% CI (0.91, 3.41), p = 0.1]. Conclusion Splenectomy is associated with higher risks of TE, but not with PH in patients with TDT.
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Affiliation(s)
- Tsampika-Vasileia Kalamara
- Adults Thalassemia Unit, Hippokration General Hospital, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Dodos
- Third Department of Pediatrics, Hippokration General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Efthymia Vlachaki
- Adults Thalassemia Unit, Hippokration General Hospital, Second Department of Internal Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Elfaituri MK, Ghozy S, Ebied A, Morra ME, Hassan OG, Alhusseiny A, Abbas AS, Sherif NA, Fernandes JL, Huy NT. Amlodipine as adjuvant therapy to current chelating agents for reducing iron overload in thalassaemia major: a systematic review, meta-analysis and simulation of future studies. Vox Sang 2021; 116:887-897. [PMID: 33634883 DOI: 10.1111/vox.13083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/19/2020] [Accepted: 01/12/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Iron overload in thalassaemia is a crucial prognostic factor and a major cause of death due to heart failure or arrhythmia. Therefore, previous research has recommended amlodipine as an auxiliary treatment to current chelating agents for reducing iron overload in thalassaemia patients. MATERIALS AND METHODS A systematic review and meta-analysis of the results of three randomized clinical trials evaluating the use of amlodipine in thalassaemia patients through 12 databases were carried out. RESULTS Our final cohort included 130 patients. Insignificant difference in decreasing liver iron concentrations was found between amlodipine and control groups {weighted mean difference = -0·2, [95% confidence interval = (-0·55-0·15), P = 0·26]}. As regards serum ferritin, our analysis also showed no significant difference in serum ferritin between amlodipine and control groups {weighted mean difference [95% confidence interval = -0·16 (-0·51-0·19), P = 0·36]}. Similarly, there was insignificant difference in cardiac T2* between amlodipine and control groups {weighted mean difference [95% confidence interval = 0·34 (-0·01-0·69), P = 0·06]}. CONCLUSIONS Despite the growing evidence supporting the role of amlodipine in reducing iron overload in thalassaemia patients, our meta-analysis did not find that evidence collectively significant. The results of our simulation suggest that when more data are available, a meta-analysis with more randomized clinical trials could provide more conclusive insights.
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Affiliation(s)
| | - Sherief Ghozy
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt.,Neurosurgery Department, El Sheikh Zayed Specialized Hospital, Giza, Egypt
| | - Amr Ebied
- Online Research Club, Nagasaki, Japan.,Egyptian National Blood Transfusion Services, Alexandria, Egypt
| | - Mostafa Ebraheem Morra
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Osama Gamal Hassan
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, South Valley University, Qena, Egypt
| | - Ahmed Alhusseiny
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Alzhraa Salah Abbas
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Minia University, Minia, Egypt
| | - Nourin Ali Sherif
- Online Research Club, Nagasaki, Japan.,Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang, Vietnam.,School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Alkholy UM, Mohamed SA, Elhady M, Attar SE, Abdalmonem N, Zaki A. Vascular endothelial growth factor and pulmonary hypertension in children with beta thalassemia major. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2019. [DOI: 10.1016/j.jpedp.2018.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Alkholy UM, Mohamed SA, Elhady M, Attar SE, Abdalmonem N, Zaki A. Vascular endothelial growth factor and pulmonary hypertension in children with beta thalassemia major. J Pediatr (Rio J) 2019; 95:593-599. [PMID: 29859904 DOI: 10.1016/j.jped.2018.05.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 04/30/2018] [Accepted: 05/07/2018] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE The purpose of this study was to illustrate the association between vascular endothelial growth factor level and pulmonary artery hypertension in children with β-thalassemia major. METHOD This case-control study was conducted on 116 children with β-thalassemia major; 58 of them had pulmonary artery hypertension. They were compared to 58 healthy children who were age and sex-matched (control group). Serum levels of vascular endothelial growth factor and echocardiographic assessment were done for all children. RESULTS Vascular endothelial growth factor serum level was significantly higher in children with β-thalassemia major with pulmonary artery hypertension than in those without pulmonary artery hypertension, as well as in control groups (p<0.001). Vascular endothelial growth factor serum level had a significant positive correlation with pulmonary artery pressure and serum ferritin, as well as a significant negative correlation with the duration of chelation therapy. Logistic regression analysis revealed that elevated vascular endothelial growth factor (Odd Ratio=1.5; 95% Confidence Interval, 1.137-2.065; p=0.005) was an independent risk factor of pulmonary artery hypertension in such children. Vascular endothelial growth factor serum level at a cutoff point of >169pg/mL had 93.1% sensitivity and 93.1% specificity for the presence of pulmonary artery hypertension in children with β-thalassemia major. CONCLUSION Elevated vascular endothelial growth factor serum level is associated with pulmonary artery hypertension in children with β-thalassemia.
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Affiliation(s)
- Usama M Alkholy
- Zagazig University, Faculty of Medicine, Department of Pediatrics, Kassala, Egypt.
| | - Soma Abdalla Mohamed
- Al-Azhar University, Faculty of Medicine, Department of Pediatrics (for girls), Cairo, Egypt
| | - Marwa Elhady
- Al-Azhar University, Faculty of Medicine, Department of Pediatrics (for girls), Cairo, Egypt
| | - Shahinaz El Attar
- Al-Azhar University, Faculty of Medicine, Department of Biochemistry (for girls), Cairo, Egypt
| | - Nermin Abdalmonem
- Zagazig University, Faculty of Medicine, Department of Pediatrics, Kassala, Egypt
| | - Ahmed Zaki
- Mansoura University, Faculty of Medicine, Department of Pediatrics, Mansoura, Egypt
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Rashidi F, Sate H, Mohammadi A, Koohi A, Nejati B, Naybzadeh A. Echocardiographic evaluation of prevalence of pulmonary hypertension in β-thalassemia major: A cross sectional study. Pediatr Hematol Oncol 2018; 35:322-330. [PMID: 30468099 DOI: 10.1080/08880018.2018.1534914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Pulmonary hypertension is a common complication associated with thalassemia syndromes and it may play an important role in the pathogenesis of right ventricle failure. The true prevalence of pulmonary hypertension in patients with thalassemia major remains unclear and has been reported to be between 2 and 79%. MATERIALS AND METHODS In total, 70 patients with thalassemia major were initially examined. Patients with valvular left heart disease, congenital heart diseases such as atrial septal defect (ASD) and ventricular septal defect (VSD), left heart failure, and chronic embolism were excluded. All patients with thalassemia major underwent echocardiography. Based on tricuspid regurgitation velocity (TRV), the patients were divided into the following three groups: low, medium, and high risk of pulmonary hypertension. RESULTS The mean age of the subjects was 24 y; 60.6% of the subjects were males and 39.4% of the subjects were females. Overall, three (4.5%) subjects were considered at a high risk of pulmonary hypertension. The mean hemoglobin level in the patients with a high probability of pulmonary hypertension was 8.2 g/dL and that in the patients with a low or medium probability of pulmonary hypertension was 9.1 g/dL. No significant difference was observed between the groups (p = .059). CONCLUSION This study showed that, based on new echocardiography criteria, the prevalence of pulmonary hypertension secondary to β-thalassemia was 4.5% and there was no correlation between TRV and the number of received blood units or disease duration.
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Affiliation(s)
- Farid Rashidi
- a Tuberclosis and Lung Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Hossein Sate
- b Department of Cardiology, Cardiovascular Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Ali Mohammadi
- a Tuberclosis and Lung Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Ata Koohi
- a Tuberclosis and Lung Disease Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Babak Nejati
- c Oncology Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
| | - Ahad Naybzadeh
- c Oncology Research Center , Tabriz University of Medical Sciences , Tabriz , Iran
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