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Cardiac mortality in β‐thalassemia major: resting but not dobutamine stress echocardiography predicts mortality among initially cardiac disease‐free patients in a prospective 12‐year study
Author(s) -
Hahalis George,
Kourakli Alexandra,
Gerasimidou Ioanna,
Kalogeropoulos Andreas P.,
Sitafidis George,
Papageorgiou Urania,
Davlouros Periklis,
Grapsas Nikos,
Zoumbos Nicholas C.,
Alexopoulos Dimitrios
Publication year - 2009
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfp152
Subject(s) - medicine , ejection fraction , cardiology , dobutamine , heart failure , prospective cohort study , ferritin , clinical endpoint , cardiac function curve , thalassemia , chelation therapy , randomized controlled trial , hemodynamics
Aims Cardiac death remains the principal cause of mortality in β‐thalassemia major (β‐TM). Echocardiography may provide additional information, incremental to haematological profile, both for guiding chelation therapy and to assess prognosis. Methods and results Between 1993 and 1995, 36 patients with β‐TM and normal cardiac function and 25 normal volunteers underwent evaluation using resting and dobutamine stress echocardiography (DSE). Dobutamine stress echocardiography was performed at baseline and repeated after 2 years. The primary endpoint was cardiac mortality. During a 12‐year observation period, seven patients (19%) died from heart failure. All seven deaths occurred among the cohort of 12 patients with median ferritin concentrations ≥2800 ng/mg. In addition, a resting left ventricular ejection fraction (LVEF), 60% was also associated with increased late mortality. In multivariate analysis, increased serum ferritin levels and reduced LVEF but not DSE or other haematological variables were independent survival determinants. Conclusion Resting LVEF provides prognostic information that is additional to ferritin levels among patients with β‐TM.