On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure

<p>Abstract</p> <p>Background</p> <p>Trials of iron chelator regimens have increased the treatment options for cardiac siderosis in beta-thalassemia major (TM) patients. Treatment effects with improved left ventricular (LV) ejection fraction (EF) have been observed in p...

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Main Authors: Carpenter JP, Pennell DJ, Roughton M, Cabantchik ZI
Format: Article
Language:English
Published: BMC 2011-09-01
Series:Journal of Cardiovascular Magnetic Resonance
Online Access:http://www.jcmr-online.com/content/13/1/45
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spelling doaj-01e2438bf85b49be92793d9c4eae919e2020-11-25T00:33:42ZengBMCJournal of Cardiovascular Magnetic Resonance1097-66471532-429X2011-09-011314510.1186/1532-429X-13-45On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failureCarpenter JPPennell DJRoughton MCabantchik ZI<p>Abstract</p> <p>Background</p> <p>Trials of iron chelator regimens have increased the treatment options for cardiac siderosis in beta-thalassemia major (TM) patients. Treatment effects with improved left ventricular (LV) ejection fraction (EF) have been observed in patients without overt heart failure, but it is unclear whether these changes are clinically meaningful.</p> <p>Methods</p> <p>This retrospective study of a UK database of TM patients modelled the change in EF between serial scans measured by cardiovascular magnetic resonance (CMR) to the relative risk (RR) of future development of heart failure over 1 year. Patients were divided into 2 strata by baseline LVEF of 56-62% (below normal for TM) and 63-70% (lower half of the normal range for TM).</p> <p>Results</p> <p>A total of 315 patients with 754 CMR scans were analyzed. A 1% absolute increase in EF from baseline was associated with a statistically significant reduction in the risk of future development of heart failure for both the lower EF stratum (EF 56-62%, RR 0.818, p < 0.001) and the higher EF stratum (EF 63-70%, RR 0.893 p = 0.001).</p> <p>Conclusion</p> <p>These data show that during treatment with iron chelators for cardiac siderosis, small increases in LVEF in TM patients are associated with a significantly reduced risk of the development of heart failure. Thus the iron chelator induced improvements in LVEF of 2.6% to 3.1% that have been observed in randomized controlled trials, are associated with risk reductions of 25.5% to 46.4% for the development of heart failure over 12 months, which is clinically meaningful. In cardiac iron overload, heart mitochondrial dysfunction and its relief by iron chelation may underlie the changes in LV function.</p> http://www.jcmr-online.com/content/13/1/45
collection DOAJ
language English
format Article
sources DOAJ
author Carpenter JP
Pennell DJ
Roughton M
Cabantchik ZI
spellingShingle Carpenter JP
Pennell DJ
Roughton M
Cabantchik ZI
On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
Journal of Cardiovascular Magnetic Resonance
author_facet Carpenter JP
Pennell DJ
Roughton M
Cabantchik ZI
author_sort Carpenter JP
title On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
title_short On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
title_full On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
title_fullStr On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
title_full_unstemmed On improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
title_sort on improvement in ejection fraction with iron chelation in thalassemia major and the risk of future heart failure
publisher BMC
series Journal of Cardiovascular Magnetic Resonance
issn 1097-6647
1532-429X
publishDate 2011-09-01
description <p>Abstract</p> <p>Background</p> <p>Trials of iron chelator regimens have increased the treatment options for cardiac siderosis in beta-thalassemia major (TM) patients. Treatment effects with improved left ventricular (LV) ejection fraction (EF) have been observed in patients without overt heart failure, but it is unclear whether these changes are clinically meaningful.</p> <p>Methods</p> <p>This retrospective study of a UK database of TM patients modelled the change in EF between serial scans measured by cardiovascular magnetic resonance (CMR) to the relative risk (RR) of future development of heart failure over 1 year. Patients were divided into 2 strata by baseline LVEF of 56-62% (below normal for TM) and 63-70% (lower half of the normal range for TM).</p> <p>Results</p> <p>A total of 315 patients with 754 CMR scans were analyzed. A 1% absolute increase in EF from baseline was associated with a statistically significant reduction in the risk of future development of heart failure for both the lower EF stratum (EF 56-62%, RR 0.818, p < 0.001) and the higher EF stratum (EF 63-70%, RR 0.893 p = 0.001).</p> <p>Conclusion</p> <p>These data show that during treatment with iron chelators for cardiac siderosis, small increases in LVEF in TM patients are associated with a significantly reduced risk of the development of heart failure. Thus the iron chelator induced improvements in LVEF of 2.6% to 3.1% that have been observed in randomized controlled trials, are associated with risk reductions of 25.5% to 46.4% for the development of heart failure over 12 months, which is clinically meaningful. In cardiac iron overload, heart mitochondrial dysfunction and its relief by iron chelation may underlie the changes in LV function.</p>
url http://www.jcmr-online.com/content/13/1/45
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