Valiollah Mehrzad1, Amirreza Sajjadieh Khajouei2, Elaheh Fahami3. 1. Department of Internal Medicine, Division of Haematology, Isfahan University of Medical Sciences, Isfahan, Iran. 2. Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran. 3. Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract
BACKGROUND: Cardiac death secondary to myocardial iron toxicity occurs in 50% of patients with transfusion-dependent β-thalassaemia major. N-terminal pro-B-type natriuretic peptide (NT-proBNP) seems to be a useful tool for early detection of cardiac haemosiderosis. We designed this study to determine whether plasma NT-proBNP levels are predictive of cardiac iron concentration, based on heart T2* assessment by magnetic resonance imaging (MRI). MATERIALS AND METHODS: We evaluated plasma NT-proBNP levels in 50 patients with β-thalassaemia major, aged 18 to 46 years, with preserved left ventricular systolic function, all of whom had undergone cardiac MRI within 3 months before the study. Next, three groups were defined based on heart T2* value as: group A, patients without evidence of cardiac iron overload (T2*>20 ms); group B, patients with mild to moderate cardiac iron overload (10 ms<T2*<20 ms); group C, patients with severe cardiac iron overload (T2*<10 ms). RESULTS: NT-proBNP level was not similar among the three groups (p=0.03), being significantly higher in patients in group C (1,104.2±350.5 pg/mL) than in patients in group B (565.9±116.9 pg/mL, p=0.03) or group A (563.5±162.5 pg/mL, p=0.04). The analyses indicate that NT-proBNP levels did not correlate with cardiac iron concentrations (r=0.152, p=0.148). DISCUSSION: Based on our study, measurements of NT-proBNP levels are not sufficient for early detection of cardiac iron overload. However, NT-proBNP measurements might be used as a tool to guide iron chelation therapy in patients with severe cardiac iron overload. The determination of their clinical use still requires multicentre studies.
BACKGROUND:Cardiac death secondary to myocardial iron toxicity occurs in 50% of patients with transfusion-dependent β-thalassaemia major. N-terminal pro-B-type natriuretic peptide (NT-proBNP) seems to be a useful tool for early detection of cardiac haemosiderosis. We designed this study to determine whether plasma NT-proBNP levels are predictive of cardiac iron concentration, based on heart T2* assessment by magnetic resonance imaging (MRI). MATERIALS AND METHODS: We evaluated plasma NT-proBNP levels in 50 patients with β-thalassaemia major, aged 18 to 46 years, with preserved left ventricular systolic function, all of whom had undergone cardiac MRI within 3 months before the study. Next, three groups were defined based on heart T2* value as: group A, patients without evidence of cardiac iron overload (T2*>20 ms); group B, patients with mild to moderate cardiac iron overload (10 ms<T2*<20 ms); group C, patients with severe cardiac iron overload (T2*<10 ms). RESULTS: NT-proBNP level was not similar among the three groups (p=0.03), being significantly higher in patients in group C (1,104.2±350.5 pg/mL) than in patients in group B (565.9±116.9 pg/mL, p=0.03) or group A (563.5±162.5 pg/mL, p=0.04). The analyses indicate that NT-proBNP levels did not correlate with cardiac iron concentrations (r=0.152, p=0.148). DISCUSSION: Based on our study, measurements of NT-proBNP levels are not sufficient for early detection of cardiac iron overload. However, NT-proBNP measurements might be used as a tool to guide iron chelation therapy in patients with severe cardiac iron overload. The determination of their clinical use still requires multicentre studies.
Authors: John-Paul Carpenter; Taigang He; Paul Kirk; Michael Roughton; Lisa J Anderson; Sofia V de Noronha; Mary N Sheppard; John B Porter; J Malcolm Walker; John C Wood; Renzo Galanello; Gianluca Forni; Gualtiero Catani; Gildo Matta; Suthat Fucharoen; Adam Fleming; Michael J House; Greg Black; David N Firmin; Timothy G St Pierre; Dudley J Pennell Journal: Circulation Date: 2011-03-28 Impact factor: 29.690
Authors: Dimitrios Th Kremastinos; Dimitrios P Tsiapras; Anna G Kostopoulou; Eftihia S Hamodraka; Antigoni S Chaidaroglou; Evangelia D Kapsali Journal: Eur J Heart Fail Date: 2007-02-21 Impact factor: 15.534
Authors: G J H Snel; M van den Boomen; L M Hernandez; C T Nguyen; D E Sosnovik; B K Velthuis; R H J A Slart; R J H Borra; N H J Prakken Journal: J Cardiovasc Magn Reson Date: 2020-05-11 Impact factor: 5.364