The Role of Arterial Stiffness Measurement in Cardiovascular Disease Assessment in Patients with Thalassemia Major

Project no. 32317 · Status: Kapanmış (Yayın bekleniyor) · 2024

Summary

<p class="ql-align-justify"><strong>Introduction</strong></p><p class="ql-align-justify">In&nbsp;thalassemia&nbsp;major,&nbsp;iron&nbsp;overload&nbsp;due&nbsp;to&nbsp;regular&nbsp;transfusions&nbsp;and&nbsp;iron-catalyzed&nbsp;free&nbsp;radical&nbsp;formation&nbsp;disrupts&nbsp;cellular&nbsp;integrity&nbsp;in&nbsp;vital&nbsp;organs,&nbsp;leading&nbsp;to&nbsp;significant&nbsp;morbidity&nbsp;and&nbsp;mortality.&nbsp;Although&nbsp;chelation&nbsp;therapy&nbsp;has&nbsp;improved&nbsp;survival,&nbsp;iron-related&nbsp;cardiomyopathy&nbsp;and&nbsp;vascular&nbsp;complications&nbsp;remain&nbsp;prevalent.</p><p class="ql-align-justify"><strong>Materials&nbsp;and&nbsp;Methods</strong></p><p class="ql-align-justify">We&nbsp;retrospectively&nbsp;analyzed&nbsp;125&nbsp;patients&nbsp;aged&nbsp;≥5&nbsp;years&nbsp;with&nbsp;thalassemia&nbsp;major&nbsp;followed&nbsp;at&nbsp;the&nbsp;Thalassemia&nbsp;Center&nbsp;between&nbsp;January&nbsp;1&nbsp;and&nbsp;December&nbsp;31,&nbsp;2025,&nbsp;alongside&nbsp;22&nbsp;age-matched&nbsp;controls.&nbsp;Iron&nbsp;load&nbsp;and&nbsp;secondary&nbsp;hemosiderosis&nbsp;were&nbsp;assessed&nbsp;from&nbsp;patient&nbsp;records.&nbsp;Physical&nbsp;examination&nbsp;and&nbsp;arterial&nbsp;stiffness&nbsp;measurements&nbsp;(augmentation&nbsp;index&nbsp;[AI]&nbsp;and&nbsp;peripheral&nbsp;pulse&nbsp;wave&nbsp;velocity&nbsp;[PWV])&nbsp;were&nbsp;performed&nbsp;using&nbsp;the&nbsp;Mobil-O-Graph&nbsp;device.&nbsp;Statistical&nbsp;analyses&nbsp;were&nbsp;conducted&nbsp;with&nbsp;IBM&nbsp;SPSS&nbsp;Statistics&nbsp;30.0.</p><p class="ql-align-justify"><strong>Results</strong></p><p class="ql-align-justify">When&nbsp;comparing&nbsp;the&nbsp;patient&nbsp;group&nbsp;with&nbsp;the&nbsp;control&nbsp;group,&nbsp;no&nbsp;statistical&nbsp;differences&nbsp;were&nbsp;found&nbsp;in&nbsp;age,&nbsp;sex,&nbsp;hypertension,&nbsp;hyperlipidemia,&nbsp;or&nbsp;family&nbsp;history.&nbsp;However,&nbsp;thalassemia&nbsp;major&nbsp;patients&nbsp;had&nbsp;higher&nbsp;procalcitonin,&nbsp;cystatin&nbsp;C&nbsp;values,&nbsp;and&nbsp;AI,&nbsp;while&nbsp;PWV&nbsp;was&nbsp;lower&nbsp;(p&lt;0.05).&nbsp;Obesity&nbsp;was&nbsp;significantly&nbsp;higher&nbsp;in&nbsp;the&nbsp;control&nbsp;group&nbsp;(p&lt;0.05).&nbsp;Among&nbsp;thalassemia&nbsp;patients,&nbsp;those&nbsp;with&nbsp;elevated&nbsp;AI&nbsp;had&nbsp;higher&nbsp;median&nbsp;ferritin&nbsp;levels,&nbsp;insulin&nbsp;resistance,&nbsp;and&nbsp;impaired&nbsp;glucose&nbsp;tolerance&nbsp;compared&nbsp;to&nbsp;those&nbsp;with&nbsp;normal&nbsp;AI&nbsp;(p&gt;0.05).&nbsp;Splenectomized&nbsp;patients&nbsp;had&nbsp;lower&nbsp;AI&nbsp;values&nbsp;(p&lt;0.05).&nbsp;No&nbsp;statistically&nbsp;significant&nbsp;differences&nbsp;were&nbsp;found&nbsp;regarding&nbsp;liver&nbsp;LIC&nbsp;(mg/g&nbsp;dw),&nbsp;cardiac&nbsp;T2*&nbsp;measurements,&nbsp;OGTT&nbsp;responses,&nbsp;presence&nbsp;of&nbsp;hyperlipidemia,&nbsp;elevated&nbsp;CRP&nbsp;and&nbsp;procalcitonin,&nbsp;hypothyroidism&nbsp;and&nbsp;hypoparathyroidism,&nbsp;or&nbsp;vitamin&nbsp;D&nbsp;deficiency.&nbsp;When&nbsp;PWV&nbsp;was&nbsp;categorized&nbsp;as&nbsp;low,&nbsp;normal,&nbsp;and&nbsp;high,&nbsp;median&nbsp;age&nbsp;was&nbsp;significantly&nbsp;higher&nbsp;in&nbsp;males&nbsp;with&nbsp;low&nbsp;peripheral&nbsp;pulse&nbsp;wave&nbsp;velocity.&nbsp;In&nbsp;the&nbsp;group&nbsp;with&nbsp;high&nbsp;PWV,&nbsp;BMI&nbsp;was&nbsp;higher,&nbsp;and&nbsp;all&nbsp;8&nbsp;patients&nbsp;were&nbsp;male&nbsp;(p&lt;0.05).</p><p class="ql-align-justify"><strong>Discussion</strong></p><p>As&nbsp;thalassemia&nbsp;patients&nbsp;live&nbsp;longer,&nbsp;chronic&nbsp;iron&nbsp;exposure&nbsp;and&nbsp;oxidative&nbsp;stress&nbsp;exert&nbsp;cumulative&nbsp;vascular&nbsp;effects,&nbsp;contributing&nbsp;to&nbsp;accelerated&nbsp;vascular&nbsp;aging.&nbsp;Arterial&nbsp;stiffness&nbsp;in&nbsp;thalassemia&nbsp;correlates&nbsp;with&nbsp;male&nbsp;sex,&nbsp;BMI,&nbsp;and&nbsp;serum&nbsp;ferritin&nbsp;levels.&nbsp;Monitoring&nbsp;arterial&nbsp;stiffness&nbsp;alongside&nbsp;iron&nbsp;load&nbsp;may&nbsp;provide&nbsp;insights&nbsp;into&nbsp;early&nbsp;cardiovascular&nbsp;involvement&nbsp;in&nbsp;this&nbsp;population.</p><p class="ql-align-center"></p><p><strong>Key&nbsp;Words:&nbsp;</strong>Iron&nbsp;load,&nbsp;Thalassemia&nbsp;major,&nbsp;Cardiac&nbsp;involvement,&nbsp;Arterial&nbsp;stiffness</p><p class="ql-align-center"></p>

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