Premium
Gender differences in the development of cardiac complications: a multicentre study in a large cohort of thalassaemia major patients to optimize the timing of cardiac follow‐up
Author(s) -
Pepe Alessia,
Gamberini Maria R.,
Missere Massimiliano,
Pistoia Laura,
Mangione Maurizio,
Cuccia Liana,
Spasiano Anna,
Maffei Silvia,
Cadeddu Christian,
Midiri Massimo,
Borgna Caterina,
Meloni Antonella
Publication year - 2018
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.15125
Subject(s) - medicine , cohort , heart failure , cardiology , cardiac dysfunction , cohort study , pediatrics
Summary We assessed whether male gender was associated with a higher risk of cardiac iron accumulation and fibrosis, heart dysfunction and complications in a large, multicentre cohort of thalassaemia major ( TM ) patients, in order to optimize the timing in cardiac follow‐up. We considered 1711 TM patients (899 females, 31·09 ± 9·08 years), enrolled in the Myocardial Iron Overload in Thalassaemia Network. Clinical/instrumental data are recorded from birth to the first Cardiovascular Magnetic Resonance Imaging scan. Although having a similar risk of accumulating iron, males showed a significantly higher risk of developing cardiac dysfunction, heart failure, arrhythmias and cardiac complications overall, when compared to females ( P < 0·0001). Up to 20–30 years of follow‐up, the Kaplan–Meier curves for the outcomes for which the male sex was a significant prognosticator almost overlapped, whereas they clearly diverged after this period. In patients with follow‐up longer than 20 years, males exhibited a significantly higher risk of ventricular dysfunction, heart failure, arrhythmias, and cardiac complications. Female patients may have an intrinsically better tolerance for iron toxicity. International guidelines suggest annual cardiac evaluation for thalassaemia patients. It is possible that female patients can be evaluated at longer intervals, thus reducing health costs.