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Right Ventricular Cardiac Dysfunction in β-Thalassemia Major FREE

Ariel Koren (Kurlat), MD; Itzhak Garty, MD; Dante Antonelli, MD; Eliahu Katzuni, MD
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Accepted for publication July 14, 1986.

Reprints not available.


Am J Dis Child. 1987;141(1):93-96. doi:10.1001/archpedi.1987.04460010093035.
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• In patients with iron overload associated with severe, transfusion-dependent β-thalassemia, congestive heart failure develops during the second decade of life. Biventricular heart function Was studied by multigated radionuclide angiography In 22 patients with β-thalassemia major. Six patients were symptomatic. Congestive heart failure developed in five patients at the time of blood transfusions, and one other patient had been treated for multiple ventricular extrasystole. The mean (±SD) left ventricular ejection fraction was normal (63.0%± 7.6%). Only one patient had a left ventricular ejection fraction under the normal level (<50%). The mean (± SD) right ventricular fraction (RVEF) was 33.3%±9.4%. In only three patients Was the RVEF normal (≥40%); an RVEF under 30% was registered in six patients. We suggest that the early right ventricular dysfunction in patients with β-thalassemia may be due to pulmonary hypertension secondary to iron overload and iron deposits in the ventricles.

(AJDC 1987;141:93-96)

REFERENCES

Engle MA, Erlandson M, Smith CH:  Late cardiac complications of chronic severe, refractory anemia with hemochromatosis . Circulation 1964;;30:698-705.
Engle MA:  Cardiac involvement in Cooley's anemia . Ann NY Acad Sci 1964;;119:694-702.
Henry WL, Nienhuis AW, Weiner M, et al:  Echocardiographic abnormalities in patients with transfusion-dependent anemia and secondary myocardial iron deposition . Am J Med 1978;;64:547-555.
Hellenbrand WE, Berger HJ, O'Brien RT, et al:  Left ventricular performance in thalassemia: Combined noninvasive radionuclide and echocardiography assessment . Circulation 1977;;55,56( (suppl 3) ):III-49.
Leon MB, Borer JS, Bacharach SL, et al:  Detection of early cardiac dysfunction in patients with severe β-thalassemia and chronic iron overload . N Engl J Med 1979;;301:1143-1148.
Covitz W, Eubig C, Balfour IC, et al:  Exercise induced cardiac dysfunction in sickle cell anemia: A radionuclide study . Am J Cardiol 1983;;51:570-575.
Manno BV, Burka ER, Hakki A, et al:  Biventricular function in sickle cell anemia: Radionuclide angiographic and thallium-201 scintigraphic evaluation . Am J Cardiol 1983;;52: 584-587.
Strauss HW, Zaret BL, Hurley PJ, et al:  A scintiphotographic method for measuring left ventricular ejection fraction in man without cardiac catheterization . Am J Cardiol 1971;;28: 575-580.
Rigo P, Murray M, Taylor DR, et al:  Right ventricular dysfunction detected by gated scintiphotography in patients with acute inferior myocardial infarction . Circulation 1975;;52: 268-274.
Hurwitz RA, Treves S, Kuruc A:  Right ventricular and left ventricular ejection fraction in pediatric patients with normal hearts: Firstpass radionuclide angiocardiography . Am Heart J 1984;;107:726-732.
Winzelberg GG:  Diminished right ventricular ejection fraction in radionuclide cardiography . Semin Nucl Med 1982;;12:304-305.
Bothwell TH, Alper T:  The cardiac complications of haemochromatosis: Report of a case with a review of the literature . S Afr J Clin Sci 1951;;2:226-238.
MacDonald RA, Mallory GK:  Hemochromatosis and hemosiderosis: Study of 211 autopsied cases . Arch Intern Med 1960;;105:686-701.
Buja LM, Roberts WC:  Iron in the heart: Etiology and clinical significance . Am J Med 1971;;51:209-221.
Gerry JG, Buckley BH, Hutchins GM:  Clinicopathologic analysis of cardiac dysfunction in 52 patients with sickle cell anemia . Am J Cardiol 1978;;42:211-216.
Arnett EN, Wienhuis AW, Henry WL, et al:  Massive myocardial hemosiderosis: A structure function conference at the National Heart and Lung Institute . Am Heart J 1975;;90:777-787.
Korr KS, Gandsman EJ, Winkler ML, et al:  Hemodynamic correlates of right ventricular ejection fraction measured with gated radionuclide angiography . Am J Cardiol 1982;;49: 71-77.
Gentzler RD, Briselli MF, Gault JH:  Angiographic estimation of right ventricular volume in man . Circulation 1974;;50:324-330.
Kahja F, Mohsin A, Goldstein S, et al:  Diagnostic value of visualization of the right ventricle using thallium-201 myocardial imaging . Circulation 1979;;59:182-188.
Matthay R, Berger HJM, Loke J, et al:  Right and left ventricular performance in cyctic fibrosis: Assessment of noninvasive radionuclide angiocardiography . Chest 1977;;72:407.
Buja ML, Roberts WC:  Iron in the heart: Etiology and clinical significance . Am J Med 1971;;51:209-221.

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References

Engle MA, Erlandson M, Smith CH:  Late cardiac complications of chronic severe, refractory anemia with hemochromatosis . Circulation 1964;;30:698-705.
Engle MA:  Cardiac involvement in Cooley's anemia . Ann NY Acad Sci 1964;;119:694-702.
Henry WL, Nienhuis AW, Weiner M, et al:  Echocardiographic abnormalities in patients with transfusion-dependent anemia and secondary myocardial iron deposition . Am J Med 1978;;64:547-555.
Hellenbrand WE, Berger HJ, O'Brien RT, et al:  Left ventricular performance in thalassemia: Combined noninvasive radionuclide and echocardiography assessment . Circulation 1977;;55,56( (suppl 3) ):III-49.
Leon MB, Borer JS, Bacharach SL, et al:  Detection of early cardiac dysfunction in patients with severe β-thalassemia and chronic iron overload . N Engl J Med 1979;;301:1143-1148.
Covitz W, Eubig C, Balfour IC, et al:  Exercise induced cardiac dysfunction in sickle cell anemia: A radionuclide study . Am J Cardiol 1983;;51:570-575.
Manno BV, Burka ER, Hakki A, et al:  Biventricular function in sickle cell anemia: Radionuclide angiographic and thallium-201 scintigraphic evaluation . Am J Cardiol 1983;;52: 584-587.
Strauss HW, Zaret BL, Hurley PJ, et al:  A scintiphotographic method for measuring left ventricular ejection fraction in man without cardiac catheterization . Am J Cardiol 1971;;28: 575-580.
Rigo P, Murray M, Taylor DR, et al:  Right ventricular dysfunction detected by gated scintiphotography in patients with acute inferior myocardial infarction . Circulation 1975;;52: 268-274.
Hurwitz RA, Treves S, Kuruc A:  Right ventricular and left ventricular ejection fraction in pediatric patients with normal hearts: Firstpass radionuclide angiocardiography . Am Heart J 1984;;107:726-732.
Winzelberg GG:  Diminished right ventricular ejection fraction in radionuclide cardiography . Semin Nucl Med 1982;;12:304-305.
Bothwell TH, Alper T:  The cardiac complications of haemochromatosis: Report of a case with a review of the literature . S Afr J Clin Sci 1951;;2:226-238.
MacDonald RA, Mallory GK:  Hemochromatosis and hemosiderosis: Study of 211 autopsied cases . Arch Intern Med 1960;;105:686-701.
Buja LM, Roberts WC:  Iron in the heart: Etiology and clinical significance . Am J Med 1971;;51:209-221.
Gerry JG, Buckley BH, Hutchins GM:  Clinicopathologic analysis of cardiac dysfunction in 52 patients with sickle cell anemia . Am J Cardiol 1978;;42:211-216.
Arnett EN, Wienhuis AW, Henry WL, et al:  Massive myocardial hemosiderosis: A structure function conference at the National Heart and Lung Institute . Am Heart J 1975;;90:777-787.
Korr KS, Gandsman EJ, Winkler ML, et al:  Hemodynamic correlates of right ventricular ejection fraction measured with gated radionuclide angiography . Am J Cardiol 1982;;49: 71-77.
Gentzler RD, Briselli MF, Gault JH:  Angiographic estimation of right ventricular volume in man . Circulation 1974;;50:324-330.
Kahja F, Mohsin A, Goldstein S, et al:  Diagnostic value of visualization of the right ventricle using thallium-201 myocardial imaging . Circulation 1979;;59:182-188.
Matthay R, Berger HJM, Loke J, et al:  Right and left ventricular performance in cyctic fibrosis: Assessment of noninvasive radionuclide angiocardiography . Chest 1977;;72:407.
Buja ML, Roberts WC:  Iron in the heart: Etiology and clinical significance . Am J Med 1971;;51:209-221.

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