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Assessment of ventricular dysfunction in Egyptian children with Beta-thalassemia major. Hematol Oncol Stem Cell Ther 2020; 14:206-213. [PMID: 32758485 DOI: 10.1016/j.hemonc.2020.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/12/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE/BACKGROUND The purpose of this study was to evaluate serum cardiac troponin I and serum N-terminal (NT) pro-brain natriuretic peptide (pro-BNP) levels and the utility of tissue Doppler imaging in assessing cardiovascular changes following left ventricular (LV) dysfunction in children with beta-thalassemia major (β-TM). In children with β-TM who depend on regular blood transfusion, cardiac iron toxicity is a common serious complication. The most common cause of death among these patients is congestive heart failure. METHODS This is a cross-sectional study which included 50 patients with β-TM and 50 healthy controls. Tissue Doppler imaging was performed and levels of serum ferritin, cardiac troponin I, and NT pro-BNP were estimated for all included patients. RESULTS Serum NT pro-BNP and cardiac troponin (cTnI) showed a significant increase in patients with β-TM (p < .001). In patients with β-TM, LV dimensions (LV end systolic diameter) and (LV end diastolic diameter) were large (p < .01); LV mass (p < .01), E wave, and E/A ratio (p < .01) were high (p < .05); and deceleration time was short (p < .05). Besides, transmitral ratio (E/Em) (p < .05) and tricuspid valve velocity were higher (p < .05), and early diastolic velocity (Em) (p < .05) and systolic wave velocity (Sm) were lower in patients with β-TM (p < .05). A significant positive correlation was detected between the pro-BNP and E wave (r = 0.558, p < .001), E/A ratio (r = 0.403, p < .001), E/Em ratio (r = 0.576, p < .001), and ferritin (r = 0.545, p < .001). CONCLUSION Pulsed wave tissue Doppler imaging and NT pro-BNP had a significant role in the estimation of ventricular dysfunction in children with β-TM.
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Noori NM, Teimouri A, Keshavarz K, Moradi M. Assessment of Aortic Elasticity and the Doppler Tissue Echocardiography in Thalassemia Major Children. JOURNAL OF CHILD SCIENCE 2020. [DOI: 10.1055/s-0040-1713595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractCardiovascular diseases are the most common illness that needs special medical care in thalassemia particularly in children and adolescents. We aimed to compare aortic stiffness in thalassemia major and healthy children. The study included 65 asymptomatic thalassemia major 6 to 19-year–old children without known history of heart disease and 65 age- and sex-matched healthy controls. Arterial stiffness indices determined using two-dimensional (2D) and Doppler echocardiography. Data were analyzed by SPSS 20.0 with 0.05 as significant error. From the study, results showed that systolic (p = 0.009) and diastolic (p < 0.001) blood pressures were higher in controls. Left ventricular mass index (LVMI) was higher in patients (p < 0.001). Aortic stiffness index (p < 0.001), pulse pressure (p < 0.001), and pressure strain elastic modulus (p < 0.001) were higher in patients, while aortic strain (p < 0.002) and aortic distensibility (p < 0.001) were lower significantly. Aortic stiffness index was correlated with diastole aorta (p = 0.005), systole aorta (p < 0.001), and LVMI (p < 0.001). Strain was correlated with diastole aorta (p < 0.001). Pulse pressure was correlated with systolic blood pressure (p < 0.001), diastolic blood pressure (p = 0.002) significantly. Aortic distensibility was correlated with systolic blood pressure (p = 0.039) and diastole aorta (p < 0.001) significantly. The pressure strain elastic modulus was correlated only with diastole aorta (p = 0.029). Concluded, aortic stiffness index, pulse pressure, and pressure strain elastic modulus were higher in thalassemia children, while aortic strain and aortic distensibility were lower. This increase may result in reduction of mechanical efficiency of the heart. Therefore, assessment of aortic elastic properties as nontraditional cardiovascular risk factors may contribute to the identification of cardiovascular risks in children with thalassemia
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children and Adolescent Health Research Center, Resistant Tuberculosis Institute, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Malihe Moradi
- School of Medicine, University of Medical Science, Zahedan, Iran
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Noori NM, Teimouri A, Shahramian I. Comparison between brain natriuretic peptide and calcitonin gene-related peptide in children with dilated cardiomyopathy and controls. Niger Med J 2017; 58:37-43. [PMID: 29238127 PMCID: PMC5715565 DOI: 10.4103/0300-1652.218413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background Dilated cardiomyopathy (DCM) is revealed with the left ventricular dilatation and systolic dysfunction. Objective This study was performed to determine the level of calcitonin gene-related peptide (CGRP) and brain natriuretic peptide (BNP) in children with DCM and controls and comparison of these two biomarkers in patients. Materials and Methods This study was performed from April 2014 to March 2015 on patients with DCM. The levels of BNP and CGRP were measured by ELISA, and final amounts of biomarkers were compared with the echocardiographic finding. Results In this study, the mean age was 10.567 ± 5.50 and 12.135 ± 4.626 years for controls and cases, respectively (P = 0.321). The majority of echocardiographic indices in the left and right heart had different means in cases and controls (P < 0.05). Means of BNP were 213.814 ± 309.601 and 2.76 ± 1.013 for case and control, respectively (P < 0.001). Means of CGRP were 2.278 ± 1.586 and 1.488 ± 0.501 for cases and controls, respectively, (P = 0.001). In the patients group, however, no significant relationship was observed between CGRP level and Ross classification but observed a direct relationship of Ross classification with BNP (χ2 = 15.845, P < 0.05). Conclusions The present research was performed on DCM patients and showed that most echocardiographic parameters, mean of CGRP and mean of BNP increased in patients compared to healthy children. The severity of illness based on the Ross classification showed significant and positive correlation with BNP level but not with CGRP. Probably, it could be concluded that BNP would be a better biomarker in DCM patients.
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Alireza Teimouri
- Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Iraj Shahramian
- Department of Pediatrics, Faculty of Medicine, Zabol University of Medical Sciences, Zabol, Iran
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Guidotti F, Piatti G, Marcon A, Cassinerio E, Giuditta M, Roghi A, Fasano V, Consonni D, Cappellini MD. Pulmonary dysfunction in thalassaemia major: is there any relationship with body iron stores? Br J Haematol 2016; 176:309-314. [PMID: 27766631 DOI: 10.1111/bjh.14396] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 08/11/2016] [Indexed: 11/30/2022]
Abstract
Although pulmonary function abnormalities in thalassaemia major (TM) were described in 1980, the pathogenetic mechanism is not clear and data are contradictory, probably because of study heterogeneity and the multifactorial nature of the pathogenesis. We retrospectively analysed 73 adult TM patients to evaluate the prevalence of pulmonary dysfunction in adult TM and investigate relationships with iron load. All patients underwent body plethysmography and carbon monoxide diffusion (DLCO) was assessed in 63, in addition to blood tests, echocardiogram and T2* myocardial and liver magnetic resonance imaging. Restrictive lung disease was present in 26 (35·6%) patients. Serum ferritin levels were higher in patients with restrictive pattern (1526 μg/l vs. 975 μg/l, P = 0·05). Restrictive lung disease did not correlate with cardiac or liver iron overload. However, considering only patients with serum ferritin >2500 μg/l, those with restrictive pattern also had heart (T2* 14·28 ± 9·99 ms vs. 31·59 ± 7·43 ms) and liver iron overload (LIC 16·02 ± 8·44 mg vs. 5·02 ± 2·69 mg Fe/g dry weight) compared to those without restrictive pattern. Twenty-five patients (39·7%) had decreased DLCO. No correlation was observed with iron parameters. In our data restrictive pattern was predominant; we observed a relationship with serum ferritin levels suggesting that iron, particularly its chronic effect, could play a role in the pathogenesis of pulmonary disease.
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Affiliation(s)
- Francesca Guidotti
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Gioia Piatti
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Alessia Marcon
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Elena Cassinerio
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Marianna Giuditta
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Alberto Roghi
- CMR Unit, Department of Cardiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Valter Fasano
- Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Domenica Cappellini
- Rare Diseases Centre, Department of Medicine and Medical Specialities, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli studi di Milano, Milan, Italy
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Noori NM, Mahjoubifard M, Mohammadi M, Jahangiri Fard A, Abassi A, Farzanegan B. Comparison of QT Dispersion With Left Ventricular Mass Index in Early Diagnosis of Cardiac Dysfunction in Patients With β-Thalassemia Major. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e11698. [PMID: 25031849 PMCID: PMC4082509 DOI: 10.5812/ircmj.11698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 11/19/2013] [Accepted: 12/19/2013] [Indexed: 12/02/2022]
Abstract
Background: In electrocardiography (ECG), QT is the interval between the onset of Q wave to the end of the T wave. This interval may be a sign of changes in the ventricular structure in hematologic disorders such as thalassemia major. Objectives: The main goal of this study was to compare the diagnostic value of corrected QT dispersion (QTcd) and QT dispersion (QTd) with left ventricular mass (LVM) and left ventricular mass index (LVMI) as well as to determine their sensitivity and specificity in early detection of the cardiac involvement in patients with β-thalassemia major. Patients and Methods: In a case-control study, 60 patients older than ten years of age with thalassemia major who received regular blood transfusion and iron chelators were selected as the case group and were compared with 60 healthy age- and sex-matched subjects. All patients had myocardial performance index (MPI) of more than 0.5 and MPI for controls was less than 0.5. Echocardiography and ECG were performed for both groups and data were analyzed using appropriate statistical tests. Results: The mean age of cases and controls were 16 ± 2.8 and 16.08 ± 3.01 years, respectively. Male to female ratio was 33:27 in case group and 31:29 in the control group. LVMI in the case group was greater than control group. QTd and QTcd were larger in case group than in control group. The sensitivity and specificity of LVM, LVMI, QTd, and QTcd were as follows: 88.3%, 77.1%; 86.7%, 80%; 93.8%, 80%; and 91.7%, 86.7%, respectively. Conclusions: This study showed acceptable sensitivity and specificity of QTcd and QTd in comparison to LVMI; it seems that standard ECG can be used for early diagnosis of cardiac involvement in asymptomatic patients with thalassemia major.
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Affiliation(s)
- Noor Mohammad Noori
- Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Maziar Mahjoubifard
- Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
- Corresponding Author: Maziar Mahjoubifard, Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel: +98-9151418089, E-mail:
| | - Mehdi Mohammadi
- Children and Adolescents’ Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran
| | - Alireza Jahangiri Fard
- Tracheal Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | | | - Behrooz Farzanegan
- Tracheal Diseases Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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Bester J, Buys AV, Lipinski B, Kell DB, Pretorius E. High ferritin levels have major effects on the morphology of erythrocytes in Alzheimer's disease. Front Aging Neurosci 2013; 5:88. [PMID: 24367334 PMCID: PMC3853801 DOI: 10.3389/fnagi.2013.00088] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/20/2013] [Indexed: 12/21/2022] Open
Abstract
Introduction: Unliganded iron both contributes to the pathology of Alzheimer's disease (AD) and also changes the morphology of erythrocytes (RBCs). We tested the hypothesis that these two facts might be linked, i.e., that the RBCs of AD individuals have a variant morphology, that might have diagnostic or prognostic value. Methods: We included a literature survey of AD and its relationships to the vascular system, followed by a laboratory study. Four different microscopy techniques were used and results statistically compared to analyze trends between high and normal serum ferritin (SF) AD individuals. Results: Light and scanning electron microscopies showed little difference between the morphologies of RBCs taken from healthy individuals and from normal SF AD individuals. By contrast, there were substantial changes in the morphology of RBCs taken from high SF AD individuals. These differences were also observed using confocal microscopy and as a significantly greater membrane stiffness (measured using force-distance curves). Conclusion: We argue that high ferritin levels may contribute to an accelerated pathology in AD. Our findings reinforce the importance of (unliganded) iron in AD, and suggest the possibility both of an early diagnosis and some means of treating or slowing down the progress of this disease.
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Affiliation(s)
- Janette Bester
- Department of Physiology, Faculty of Health Sciences, University of Pretoria Arcadia, South Africa
| | - Antoinette V Buys
- Microscopy and Microanalysis Unit, University of Pretoria Arcadia, South Africa
| | | | - Douglas B Kell
- School of Chemistry and The Manchester Institute of Biotechnology, The University of Manchester Lancs, UK
| | - Etheresia Pretorius
- Department of Physiology, Faculty of Health Sciences, University of Pretoria Arcadia, South Africa
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Hamed AES, Ragab IA, Kamel TB, Abd-El-Gawad AOA. Effect of using bedside leukocyte filter on pulmonary functions in patients with thalassemia major. Pediatr Hematol Oncol 2013; 30:761-7. [PMID: 24087980 DOI: 10.3109/08880018.2013.838724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED In settings of limited health resources, using leukocyte-filtered blood is limited to patients with leukocyte-mediated complications. The aim of this study was to determine the patterns of lung dysfunction among patients with β-thalassemia major (BTM) after the application of the leukostop filter during transfusion for a period of 6 months. The study included 30 patients with transfusion-dependent BTM divided into two groups according to the use of leukocyte filter. Group I included 15 patients with BTM allocated to use the leukocyte filter before each blood transfusion for 6 months and group II included 15 patients with BTM using nonleukocyte-filtered blood. Patients with history of airway disease and smokers were excluded. Chest X-ray and pulmonary function tests (PFT) using spirometry were done for each patient at baseline and after the use of the leukocyte filter for 6 months. No significant difference was found at baseline PFTs in both groups, the distribution of obstructive pulmonary disease significantly improved in group I in the postfilter evaluation, P < 0.05, however no change in pulmonary disease distribution in group II. A statistical significance improvement in forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1) and FEV1/FVC in postfilter evaluation, while in group II a decline in FEV1, FVC, and no significant change in FEV1/FVC ratio. There was no correlation between serum ferritin and PFT results. CONCLUSION Pulmonary function abnormalities, although subclinical is not an infrequent finding in patients with BTM; leukofiltred blood may improve PFT.
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Affiliation(s)
- Ahmed El Saiid Hamed
- Hematology-Oncology Unit, Pediatric Department, Ain Shams University , Cairo , Egypt
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Shahramian I, Razzaghian M, Ramazani AA, Ahmadi GA, Noori NM, Rezaee AR. The Correlation between Troponin and Ferritin Serum Levels in the Patients with Major Beta-Thalassemia. Int Cardiovasc Res J 2013; 7:51-5. [PMID: 24757621 PMCID: PMC3987427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Revised: 05/20/2013] [Accepted: 05/23/2013] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Thalassemia is a hereditary hemoglobinopathy whose most common complication is cardiac involvement which ends up in these patients' death. Since troponin is a sensitive and specific marker for the detection of microinfarct, we studied the relationship between troponin and ferritin serum levels for early diagnosis of cardiac involvement in these patients. MATERIALS AND METHODS This case-control study was performed on 80 patients, including 40 patients with major thalassemia and normal echocardiography and 40 healthy volunteers ranging from 6 months to 16 years old. All the children were examined and the eligible children who were not infected with known heart disease, iron deficiency anemia, kidney disease, diabetes, fever, and systemic diseases were enrolled into the study after obtaining written informed consents from their parents. At 8:00 A.M. before breakfast, 5cc blood was drawn from these children. After collecting the samples, ferritin and troponin serum levels were evaluated using ELISA and electro- kymonolonsense methods, respectively. The gathered data were analyzed through the SPSS statistical software (v. 20) and T-test. Besides, P value<0.05 was considered as statistically significant. RESULTS The study results revealed a significant difference between the two groups regarding the mean of the serum levels of troponin (P=0.045) and ferritin (P=0.001). In this study, no significant correlation was observed between serum troponin and ferritin levels and age and BMI in the two groups. Also, no significant relationship was found between serum troponin level and sex (P=0.264). CONCLUSIONS In microinfarct, troponin increases independent of ferritin; therefore, it can be used for early detection of cardiac involvement in thalassemia patients to determine the sub-clinical effects.
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Affiliation(s)
- Iraj Shahramian
- Department of Pediatrics, Zabol University of Medical Sciences, Zabol, IR Iran
| | | | - Abbas Ali Ramazani
- Departement of Epidemiology, Zabol University of Medical Sciences, Zabol, IR Iran
| | - Ghasem Ali Ahmadi
- Departement of Pathology, Zabol University of Medical Sciences, Zabol, IR Iran
| | - Noor Mohammad Noori
- Pediatric Cardiology, Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran,Corresponding author: Noor Mohammad Noori, Pediatric Cardiology, Children and Adolescent Health Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel:+98-9153412106, E-mail:
| | - Ali Reza Rezaee
- Departement of Biochemistry, Zabol University of Medical Sciences, Zabol, IR Iran
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