Evaluation of carotid artery dynamics & correlation with cardiac & hepatic iron in β-thalassaemia patients

Abstract

Background & objectives:Early atherosclerosis and vascular complication have been described in thalassaemia patients. There is lack of data or guidelines regarding monitoring of vascular health in thalassaemia. This study was conducted to compare carotid artery structural and functional indices such as carotid artery intima-media thickness (CIMT), stiffness index (SI) and Young's elastic modulus (YEM) in β-thalassemia patients with age and sex matched controls, and to correlate these parameters with serum ferritin, cardiac iron, and hepatic iron.Methods:This cross-sectional study included 53 β-thalassaemia patients receiving regular blood transfusions. Carotid artery indices such as CIMT, SI, and YEM were calculated by duplex ultrasound and colour Doppler. Serum ferritin levels were measured by chemiluminescence. Cardiac and hepatic iron estimation were done using MRI T2* sequences analyzed by a special thalassaemia software.Results:Mean CIMT of cases and controls were 0.48 ± 0.04 and 0.44±0.02 mm, respectively and these were significantly different (P<0.001). Similarly significant differences were noted in SI and YEM of cases (2.45±0.79 and 96.12±34.85, respectively) as compared to controls (1.98±0.54 and 68.60±24.29, respectively) (P<0.001). There was significant inverse correlation between stiffness index and cardiac iron overload assessed by MRI cardiac T2* (P=0.03). Mean SI and YEM of cases were (2.1736 ± 0.2986 and 107.3± 41.6, respectively) significantly higher among non-splenectomized patients compared to splenectomized patients (2.0136 ± 0.263 and 86.9 ± 25.2, respectively) (P<0.05).Interpretation & conclusions:CIMT and arterial stiffness indices were significantly increased in β-thalassaemia patients compared to controls which was indicative of early atherogenic changes. This study supports the hypothesis that iron overload is a risk factor for early atherosclerosis and cardiovascular disease.

Blockade of angiotensin AT1 receptors prevents arterial remodelling and stiffening in iron‐overloaded rats

“…Clinical studies have shown increased PWV in iron‐overloaded patients due to β‐thalassaemia major (Detchaporn et al, ; Gedikli et al, ; Ulger, Aydinok, Gurses, Levent, & Ozyurek, ) or haemochromatosis (Cash et al, ). Furthermore, Valenti et al () identified an association between hyperferritinemia and aortic stiffness in hypertensive subjects, and Merchant et al () described that arterial stiffness increased significantly as cardiac iron‐overload increased in β‐thalassaemia patients receiving regular blood transfusions. On the other hand, Stakos et al () described that, in the absence of cardiac iron‐overload, patients with β‐thalassaemia major demonstrated aortic stiffening.…”

Assessment of Atherosclerosis in Peripheral and Central Circulation in Adult β Thalassemia Intermedia Patients by Color Doppler Ultrasound: Egyptian Experience

“…In another study on transfusion-dependent thalassemia patients, carotid intimal media thickness (CIMT) and stiffness index (a marker for arterial wall resistance) were significantly higher than in controls (p < 0.001) with a significant correlation between CIMT and cardiac iron overload but not hepatic iron load. Moreover, they clas-sified the patients according to their age group and found that increasing age was associated with a greater increase in CIMT [24]. One study conducted on transfusion-independent TI also found an increase in CIMT compared to controls with a p value of 0.049 [25].…”

Luspatercept (Reblozyl)

“…30,31 Correlation was not supported in all studies, specifically, those where serum ferritin was compared with cardiac T2*, 28 adrenal T2*, 32 and carotid artery structure or vascular health. 33 Additionally, evidence from 1 study that investigated the relationships between changes in liver iron concentrations and changes in serum ferritin determined that serum ferritin nonresponse was associated with a decrease in liver iron concentrations in more than half of patients and concluded that the use of liver MRI may be particularly useful, as serum ferritin trends can be misleading. 34 Overall, given the low quality of evidence and absence of studies assessing reliability and responsiveness, strong conclusions on the use of serum ferritin levels cannot be made.…”