Objective: To evaluate left ventricular morphology and function in a large population of patients with β thalassaemia. Design: Echo Doppler assessment of left ventricular function and correlation of cardiovascular data with haematological data. Setting: Thalassaemia unit in a tertiary referral centre. Patients: 197 young adults with β thalassaemia, following an adequate transfusional and chelation treatment regimen, without clinical signs of cardiopulmonary involvement. The control group consisted of 213 healthy subjects. Results: Left ventricular volumes, mass index, and mass/volume ratio were increased. Diastolic and systolic shapes were different, the left ventricle maintaining an ellipsoidal shape. The ejection fraction was reduced, and was < 50% in 33 patients. Stroke volume and cardiac index were increased, and systemic vascular resistance was decreased. Fractional shortening and mean velocity of circumferential shortening were decreased. Meridional end systolic and peak systolic stress were increased, as was circumferential end systolic stress. The contractile state was reduced while the functional preload index did not differ. Left ventricular diastolic function, evaluated from the mitral inflow, showed a slightly prolonged isovolumic relaxation time, increased flow velocity integrals, and an increased E/A ratio. Among the haematological data, only serum ferritin showed a weak negative correlation with left ventricular ejection fraction. The patients with the highest serum ferritin (> 2500 ng/ml) had the lowest ejection fraction. Conclusions: Patients with β thalassaemia on an adequate transfusion and chelation treatment regimen show abnormal left ventricular remodelling with increased volumes, mass, and mass/volume ratio. Systolic chamber function and contractile state are reduced, with a slightly increased afterload. These findings seem mainly to be related to the increased cardiac output caused by chronic anaemia. Left ventricular performance is better preserved when chelation treatment is adjusted to maintain the serum ferritin concentration at < 1000 ng/ml. C ardiac complications such as heart failure and arrhythmias, caused by the so called "iron induced" cardiomyopathy, are considered to be the primary cause of death in patients with β thalassaemia major.1 Left ventricular systolic and diastolic function in patients with β thalassaemia with varying degrees of cardiac involvement including heart failure has recently been investigated by Doppler echocardiography. However, the findings-mostly concerned with left ventricular diastolic function-are somewhat conflicting. 2-4The present study was carried out in a large population of young adults with β thalassaemia major, who were following a carefully monitored transfusion and chelation therapy regimen, in order to evaluate morphological and functional changes in the left ventricle, and to correlate the echocardiographic findings with the haematological data. METHODS Study populationOf the 273 patients followed in the outpatients service of the thalassa...

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ARF following PCI occurs almost exclusively in patients with chronic kidney disease or left ventricular dysfunction. These risk factors are also among the most powerful predictors of long-term mortality and are likely to explain most of the association between postprocedural ARF and long-term mortality. After correction for clinical determinants, however, postprocedural ARF maintains a clinically significant impact on mortality that must be taken into account for benefit vs. risk evaluation of PCI in individual patients.