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Derchi G, Dessì C, Bina P, Cappellini MD, Piga A, Perrotta S, Tartaglione I, Giuditta M, Longo F, Origa R, Quarta A, Pinto V, Forni GL. Risk factors for heart disease in transfusion-dependent thalassemia: serum ferritin revisited. Intern Emerg Med 2019; 14:365-370. [PMID: 29948832 DOI: 10.1007/s11739-018-1890-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 06/06/2018] [Indexed: 01/19/2023]
Abstract
Heart disease remains a leading cause of morbidity and mortality in transfusion-dependent thalassemia (TDT), which can be attributed to several factors but primarily develops in the setting of iron overload. This was a retrospective cohort study utilizing Webthal® patient data from five major centers across Italy. Patients without heart disease were followed-up for 10 years (2000-2010) and data were collected for demographics, splenectomy status, serum ferritin and hemoglobin levels, and comorbidities associated with heart disease. Among 379 patients analyzed (mean age 22.9 ± 5.1 years, 47.8% men), 44 (cumulative incidence: 11.6%) developed heart disease during the period of observation. Splenectomy (p = 0.002) and serum ferritin level (p < 0.001) were the only risk factors with significant association with heart disease. A serum ferritin threshold of ≥ 3000 ng/mL was the best predictor for the development of heart disease (86.4% sensitivity and 92.8% specificity, AUC: 0.912, 95% CI 0.852-0.971, p < 0.001). On multivariate analysis, only a serum ferritin level ≥ 3000 ng/mL remained significantly and independently associated with increased risk of heart disease (HR: 44.85, 95% CI 18.85-106.74), with a 5- and 10-year heart disease-free survival of 58 and 39%. The association between iron overload and heart disease in patients with TDT is confirmed, yet a new serum ferritin level of 3000 ng/mL to flag increased risk is suggested.
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Affiliation(s)
| | - Carlo Dessì
- Ospedale Regionale per le Microcitemie, ASL8, Cagliari, Italy
| | - Patrizio Bina
- Ospedale Regionale per le Microcitemie, ASL8, Cagliari, Italy
| | - Maria Domenica Cappellini
- Department of Clinical Sciences and Community, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Antonio Piga
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy
| | - Silverio Perrotta
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Immacolata Tartaglione
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Seconda Università degli Studi di Napoli, Naples, Italy
| | - Marianna Giuditta
- Department of Clinical Sciences and Community, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Filomena Longo
- Department of Clinical and Biological Sciences, Università di Torino, Turin, Italy
| | - Raffaella Origa
- Thalassemia Unit, Department of Public Health, Clinical and Molecular Medicine, Università di Cagliari, Cagliari, Italy
| | | | - Valeria Pinto
- Ematologia-Centro della Microcitemia e Anemie Congenite, Ospedale Galliera, Via Volta 6, 16128, Genoa, Italy
| | - Gian Luca Forni
- Ematologia-Centro della Microcitemia e Anemie Congenite, Ospedale Galliera, Via Volta 6, 16128, Genoa, Italy.
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Derchi G, Galanello R, Bina P, Cappellini MD, Piga A, Lai ME, Quarta A, Casu G, Perrotta S, Pinto V, Musallam KM, Forni GL. Prevalence and Risk Factors for Pulmonary Arterial Hypertension in a Large Group of β-Thalassemia Patients Using Right Heart Catheterization. Circulation 2014; 129:338-45. [DOI: 10.1161/circulationaha.113.002124] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Giorgio Derchi
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Renzo Galanello
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Patrizio Bina
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Maria Domenica Cappellini
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Antonio Piga
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Maria-Eliana Lai
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Antonella Quarta
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Gavino Casu
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Silverio Perrotta
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Valeria Pinto
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Khaled M. Musallam
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
| | - Gian Luca Forni
- From the Galliera Hospital, Genoa, Italy (G.D., V.P., G.L.F.); University of Cagliari, Cagliari, Italy (R.G., P.B., M.-E.L.); IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, University of Milan, Milan, Italy (M.D.C., K.M.M.); University of Turin, Turin, Italy (A.P.); Perrino Hospital, Brindisi, Italy (A.Q.); S. Francesco Hospital, Nuoro, Italy (G.C.); and Seconda University, Naples, Italy (S.P.)
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