The correlation study of cardiovascular functions and iron overload by echocardiographic indices in thalessemia patients

Yıl 2020, Cilt: 45 Sayı: 2, 639 - 647, 30.06.2020

Gamze Akkuş , Oğuz Akkuş , Kamil Nas , Esmeray Acartürk , Emel Gürkan

https://doi.org/10.17826/cumj.702260

Öz

Purpose: The aim of this study was to evaluate arterial stiffness with echocardiographic and oscillometric (TensioMed arteriography) methods in thalassemia patients.
Materials and Methods: We enrolled 44 participants from both gender (24 thalasemia patients, 20 control patients). Hematologic and hemodynamic parameters were recorded. Arterial stiffness was assessed non-invasively by measurement of pulse wave velocity, augmentation index, aortic strain, distensibility and arterial stiffness index by using TensioMed arteriography and echocardiography.
Results: Aortic strain and arterial stiffness index were found to be significant between two groups. Pulse wave velocity had borderline significance between thalasemia and control patients. Tissue doppler early (E ') and late (A') mitral annular diastolic filling velocities in patients with beta thalassemia were significantly lower than the control group.
Conclusion: Tissue doppler echocardiographic evaluation was useful in determining the development of diastolic dysfunction in patients with thalassemia. Arterial stiffness indices, especially aortic strain, arterial stiffness index and pulse wave velocity are a useful and easy methods to predict risk of vascular aging at thalassemia patients.

Anahtar Kelimeler

Thalassemia, iron overload

Talasemi hastalarında demir yükü ile kardiyovasküler fonksiyonların ekokardiyografik indekslerle korelasyon çalışması

Öz

Amaç: Bu çalışmada talasemi majör ve intermedia hastalarında arteryel sertlik parametrelerinin ekokardiyografik ve osilometrik (arteriograf) yöntemlerle incelenmesi amaçlanmıştır.
Gereç ve Yöntem: Çalışmaya her iki cinsiyetten 44 gönüllü katılımcı (24 talasemi hastası, 20 kontrol grubu) alındı. Hastaların hematolojik ve hemodinamik parametreleri kayıt edildi. Arteryel sertlik göstergesi olarak aortik arttırma göstergesi (aortic AG), nabız dalga hızı (NDH), aortic strain, distensibilite ve aortic sertlik indeksi bakıldı. Nabız dalga hızı ve aortic AG arteriyograf ile diğer parametreler ekokardiyografik olarak ölçüldü.
Bulgular: Vasküler kompliyans belirleyicisi olarak bakılan parametrelerden aortik strain ve arteryel sertlik indeksi iki grup arasında anlamlı saptanmıştır. Aort nabız dalga hızı talasemi hasta grubunda sınırda anlamlı saptandı. Doku doppler ölçümlerinden erken (E‟) ve geç (A‟) mitral anüler diyastolik doluş hızları beta talasemi hastalarında kontrol grubuna göre anlamlı düşük saptandı.
Sonuç: Ekokardiyografik doku doppler değerlendirmesi talasemi hastalarında diyastolik disfonksiyon gelişimini belirlemede yararlı bulunmuştur. Arteryel sertlik indeksleri, özellikle aortic strain, arteryel sertlik indeksi ve nabız dalga hızı, talasemi hastalarında demir birikimine bağlı vasküler yaşlanmayı belirlemede başvurulabilecek kolay ve güvenilir ölçümlerdir.

Anahtar Kelimeler

talasemi, arteryel sertlik

Kaynakça

• 1) Weatherall DJ. Cleeg JB. The clinical and molecular heterogeneity of the thalassemia syndromes. Ann N Y Acad Sci. 1980;344:83-100.
• 2) Huisman THJ, Carver MFH, Baysal E. Syllabus of Thalessemia Mutation. Augusta: The Sickle Cell Anemia Foundadion 1997; 1-30 3) Weatherall DJ, Clegg JB. The Thalassemia Syndromes, 4th edition, Oxford; Blackwell Scientific Publications, 2001;1760-1786 4) Banjerdpongchai R, Wilairat P, Fucharoen S, et. al. Morphological alterations and apoptosis of endotelial cells induced by thalassemic serum in vitro. Southeast Asian J Trop Med Public Health. 1997; 149-154 5) Butthep P, Khuhapinant A, Bunyaratvej A, et. al. Thallesemic serum inhibits endothelial cell mitosis in vitro. Southeast Asian J Trop Med Public Health. 1997; 155-160 6) Caro CG, Pedley TJ, Schroter RC, Seed WA. The Mechanics of the Circulation. New York, Oxford University Press, 1978; 243-349. 7) Safar ME, Levy BI, Struijker-Boudier H. Current perspectives on arteriel stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 2003; 107:2864-2869 8) Kostis J, Lawrence-Nelson J, Ranjan R, Wilson A, Kostis W, Lacy C. Association of increased pulse pressure with the development of heart failure in SHEP. Systolic Hypertension in the Elderly (SHEP) Cooperative Research. Am J Hypertens. 2001;14:798-803 9) Mitchell GF, Pfeffer MA, Braunwald E, Rouleau J-L, Bernstein V, Geltman EM, Flaker GC. Sphygmomanometrically determined pulse pressure is a powerful independent predictor of recurrent events after myocardial infarction in patients with impaired left ventricular function. Circulation 1997;96:4254-60 10) YF Cheung, SY Ha, GCF. Ventriculo-vascular interactions in patients with beta- thalassaemia majör Chan Heart 2005; 91:769–773. 11) D. A. Stakos, A. Tavridou, D. Margaritis et al. Oxidised low-density lipoprotein and arterial function in beta-thalessemia majör. European Journal of Haematology 2009; 82 (477-483) 12) Lemogoum D, Van Bortel L, Najem B, et. al. Arterial Stiffness and wave reflections in patients with sicklecell disease. Hypertension 2004; 44;924-9 13) Latham RD, Westerhof N, Sipkema P, Rubal BJ, Reuderink P, Murgo JP. Regional wave travel and reflections along the human aorta: a study with six simultaneous micromanometric pressures. Circulation 1985; 72: 1257–1269. 14) Aessopos, A. Farmakis, D. Tsironi, M. Diamanti–Kandarakis E, Matzourani M, Fragodimiri C. Endotelial function and arterial stiffness in sickle-thalassemia patients Atherosclerosis 2007;191:427-432 15) O’Rourke MF, Staessen JA, Vlachopoulos C, Duprez D, Plante GE. Clinical applications of arterial stiffness:definitions and reference values. Am J Hypertens 2002;15:426-444. 16) Nigam A, Mitchell GF, Lambert J, Tardif JC. Relation between conduit vessel stiffness (assessed by tonometry) endotelial function (assessed by flow-mediated dilatation) in patients with and without coronery hearth disease. Am J Cardiol 2003; 92:395-9 17) Kugiyama K, Kerns SA, Morrisett JD, Roberts R, Henry PD. Impairment of endotelium- dependent arterial relaxation by lysolecitin in modified low-dencity lipoproteins. Nature 1990; 344:160-2 18) Duffy SJ, Biegelsen ES, Holbrook M, et. al. Iron chelation improves endotelial function in patients with coronery artery disease. Circulation 2001; 103:2799-2804 19) Franklin SS, Larson MG, Khan SA, Wong ND, Kannel WB, Levy D. Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001; 103:1245–1249 20) Kass DA. Ventricular arterial stiffening: integrating the pathophysiology. Hypertension. 2005; 46:185-93. 21) Durier S, Fassot C, Laurent S et. al. Physiological genomics of human arteries: quantitative relationship between gene expression and arteriel stiffness. Ciculation 2003; 108:1845-51.