Correlation of NT-proBNP levels and cardiac iron concentration in patients with transfusion-dependent thalassemia major

Delaporta, Polyxeni; Kattamis, Antonios; Apostolakou, Filia; Boiu, S; Bartzeliotou, Αnastasia; Tsoukas, Evangelos; Papassotiriou, Ioannis

doi:10.1016/j.bcmd.2012.09.002

Cited by 19 publications

(25 citation statements)

References 30 publications

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“…Chronic transfusion may lead to iron‐induced cardiomyopathy in a percentage of patients. A study by Delaporta and colleagues found that there is a correlation between cardiac iron concentration and NT‐proBNP in patients with transfusion‐dependent thalassemia major quantified by cardiac MRI techniques. Our database was not screened for patients requiring frequent transfusions but could be a contributing factor in the discrepancy.…”

Section: Discussionmentioning

confidence: 99%

What Is Causing Extremely Elevated Amino Terminal Brain Natriuretic Peptide in Cancer Patients?

Popat

Rivero

Pratap

et al. 2012

Congestive Heart Failure

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High levels of B‐type natriuretic peptide in cancer patients are poorly studied. Previously published data suggest that they are not related to fluid overload and are encountered mostly in solid cancers. The authors investigated the distribution of amino terminal pro‐brain natriuretic peptide (NT‐proBNP) between hematologic and solid organ malignancies and the relationship of NT‐proBNP with volume status in oncologic patients. A total of 145 consecutive patients with at least one occurrence of NT‐proBNP exceeding the upper normal range 10‐fold were identified. The authors retrospectively reviewed their records including clinical, laboratory, and radiological data and echocardiograms. More than 70% of patients had hematologic malignancies. Patients with NT‐proBNP >50,000 pg/mL had only hematologic malignancies, primarily multiple myeloma. There was no association between M‐spike proteins and NT‐proBNP. About 80% of patients had signs of fluid overload. The magnitude of NT‐proBNP elevation was similar between those with and without heart failure or volume overload, as well as with solid cancers vs hematologic malignancies. Contrary to prior reports, it was found that very high NT‐proBNP in cancer patients is usually encountered in the context of fluid overload and most often in hematologic malignancies.

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Section: Discussionmentioning

confidence: 99%

What Is Causing Extremely Elevated Amino Terminal Brain Natriuretic Peptide in Cancer Patients?

Popat

Rivero

Pratap

et al. 2012

Congestive Heart Failure

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“…50 One possible explanation for this finding is cardiac endocrinopathy and reduced BNP secretion caused by iron toxicity. More recent data suggest that NT-proBNP levels may be useful, 93 and further studies are needed.…”

Section: Basic Testsmentioning

confidence: 99%

Cardiovascular Function and Treatment in β-Thalassemia Major

Pennell¹,

Udelson²,

Arai³

et al. 2013

Circulation

331

172

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This aim of this statement is to report an expert consensus on the diagnosis and treatment of cardiac dysfunction in β-thalassemia major (TM). This consensus statement does not cover other hemoglobinopathies, including thalassemia intermedia and sickle cell anemia, in which a different spectrum of cardiovascular complications is typical. There are considerable uncertainties in this field, with a few randomized controlled trials relating to treatment of chronic myocardial siderosis but none relating to treatment of acute heart failure. The principles of diagnosis and treatment of cardiac iron loading in TM are directly relevant to other iron-overload conditions, including in particular Diamond-Blackfan anemia, sideroblastic anemia, and hereditary hemochromatosis. Heart failure is the most common cause of death in TM and primarily results from cardiac iron accumulation. The diagnosis of ventricular dysfunction in TM patients differs from that in nonanemic patients because of the cardiovascular adaptation to chronic anemia in non–cardiac-loaded TM patients, which includes resting tachycardia, low blood pressure, enlarged end-diastolic volume, high ejection fraction, and high cardiac output. Chronic anemia also leads to background symptomatology such as dyspnea, which can mask the clinical diagnosis of cardiac dysfunction. Central to early identification of cardiac iron overload in TM is the estimation of cardiac iron by cardiac T2* magnetic resonance. Cardiac T2* <10 ms is the most important predictor of development of heart failure. Serum ferritin and liver iron concentration are not adequate surrogates for cardiac iron measurement. Assessment of cardiac function by noninvasive techniques can also be valuable clinically, but serial measurements to establish trends are usually required because interpretation of single absolute values is complicated by the abnormal cardiovascular hemodynamics in TM and measurement imprecision. Acute decompensated heart failure is a medical emergency and requires urgent consultation with a center with expertise in its management. The first principle of management of acute heart failure is control of cardiac toxicity related to free iron by urgent commencement of a continuous, uninterrupted infusion of high-dose intravenous deferoxamine, augmented by oral deferiprone. Considerable care is required to not exacerbate cardiovascular problems from overuse of diuretics or inotropes because of the unusual loading conditions in TM. The current knowledge on the efficacy of removal of cardiac iron by the 3 commercially available iron chelators is summarized for cardiac iron overload without overt cardiac dysfunction. Evidence from well-conducted randomized controlled trials shows superior efficacy of deferiprone versus deferoxamine, the superiority of combined deferiprone with deferoxamine versus deferoxamine alone, and the equivalence of deferasirox versus deferoxamine.

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“…In β-thalassemic patients, high NT-proBNP significantly correlates with documented left ventricular diastolic dysfunction, and retains predictive value in latent left ventricular diastolic dysfunction [12] . Moreover, there is a significant association between NT-proBNP levels and cardiac iron concentration in TM patients, evidencing the relationship between biochemical and imaging techniques [13] . New unexpected effects of natriuretic peptides (NP) have been recently evidenced, which suggest a role for these biomarkers as metabolic hormones.…”

Section: The Liver-pancreas-heart Triangle Ntprobnp and Diabetes Mementioning

confidence: 85%

Liver Pancreas Heart Triangle and HCV in Thalassemia: Expanding the Horizon Through Biomarker Networks

Vassalle¹,

Meloni²,

Pistoia³

et al. 2017

IJHT

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Magnetic Resonance Imaging represents the elective strategy to assess iron overload in different organs and drives the iron chelation therapy in Thalassemia major (TM). However, affected organs, in particular liver, pancreas and heart, are not isolated but interact each other and communicate through biochemical mediators, which may accelerate and worsen pathological processes considered unrelated. A better understanding of these intermingled pathways might help to identify more significant biomarker combinations and the association of these biomarkers to TM complexity, possibly assisting imaging techniques in the prevention of complications and in the improvement of life quality in TM patients.

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Correlation of NT-proBNP levels and cardiac iron concentration in patients with transfusion-dependent thalassemia major

Cited by 19 publications

References 30 publications

What Is Causing Extremely Elevated Amino Terminal Brain Natriuretic Peptide in Cancer Patients?

What Is Causing Extremely Elevated Amino Terminal Brain Natriuretic Peptide in Cancer Patients?

Cardiovascular Function and Treatment in β-Thalassemia Major

Liver Pancreas Heart Triangle and HCV in Thalassemia: Expanding the Horizon Through Biomarker Networks

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