Evaluation of acquired cardiac complications in major thalassemic patients referred to Ahvaz thalassemia center

To evaluate cardiac status in patients with thalassemia major.Subjects and The investigation included thorough history taking, clinical examination, electrocardiography, chest radiography and echocardiography. One hundred and twenty young adults with thalassemia, following an adequate transfusional and chelation treatment regimen, without clinical signs of cardiopulmonary involvement. 63 patients were female and 57 patients them were male. Mean age of the were 16.6 6 years (range 5-37 yr). Abnormal findings in ECG were found in 35.8% that the most common were nonspecific T wave and ST segment changes. Chest radiograph revealed increased cardiothoracic ratio in 30% of patients. Precardial effusion reported in 2.5%. No history of precarditis was reported in any patient. Mitral, tricuspid and pulmonary valve regurgitations were observed in 52%, 60% and 20% respectively. None of the patients had frank congestive heart failure. Ejection fraction and fractional shortening of the patients were 55.2% 5 and 31% 5 respectively. E/A <1 [early (E) and late (A) transmitral and transtricuspid peak flow velocities] were seen in 2.5% and 4.2% respectively. Pulmonary hypertension (PHT; defined as pulmonary artery pressure > 30 mmHg) was found in 8.3% of the patients, aged 19±8 yr. PHT correlated positively with irregular use of desferal (P<0.001).Age correlated negatively with ejection fraction (P<0.001), fractional shortening (P<0.05), mitral E/A (p<0.003) and tricuspid E/A (p < 0.014). In patients with abnormal ECG and CXR; ejection fraction reduced significantly (P < 0.004). Left ventricular (LV) systolic dysfunction was encountered in 23.3% of patients, aged 20 5 years. Restrictive LV filling was suggestive in 32% of patients. Despite of regular usage of desferal and standard transfusion, there is also chance of cardiac complications in thalassemics. Echocardiographic examination appears a tool more reliable than clinical, electrocardiographic and/or chest X ray examination in assessment of young adult patient with thalassemia major. At present the most powerful predictive information includes a patient’s transfusion record, serial serum ferritin levels, and compliance to a chelation regimen.