Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-24T09:44:59.108Z Has data issue: false hasContentIssue false
  • English
  • Français

The evaluation of carotid intima-media thickness in children with beta-thalassaemia major

Published online by Cambridge University Press:  27 July 2011

Mustafa Dogan  and
Elvan Caglar Citak
Mustafa Dogan
Affiliation:
Faculty of Medicine, Department of Pediatric Oncology, Mersin University, Mersin, Turkey
Elvan Caglar Citak*
Affiliation:
Faculty of Medicine, Department of Pediatric Oncology, Mersin University, Mersin, Turkey
*
Correspondence to: Dr E. C. Citak, MD, Faculty of Medicine, Department of Pediatric Oncology, Mersin University, Mersin, Turkey. Tel: +90 324 3374300; Fax: +90 324 3374305; E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Cardiovascular complications and vascular changes are common in patients with beta-thalassaemia major. The aim of this study is to investigate the common carotid artery intima-media thickness in children.

Methods

The study population was consisted of 33 thalassaemic children (22 boys and 11 girls, with a median age of 8 years) and 30 healthy children for control (12 girls and 18 boys, with a median age of 8 years) who were matched for age and gender. Common carotid artery intima-media thickness of the children was measured.

Results

The patients’ age at diagnosis ranged from 0.25 to 2 years, with a median of 0.6 months. Their disease duration ranged from 4 to 13.75 years, with a median of 6.5 years. The patients’ median common carotid artery intima-media thickness was significantly higher than controls – that is, 0.87 versus 0.74, with a p-value less than 0.005. The mean common carotid artery intima-media thickness value was positively correlated with disease duration (r = 0.535), with a p-value less than 0.01 and ferritin level (r = 0.501), with a p-value less than 0.01.

Conclusion

Owing to the nature of the disease, patients with beta-thalassaemia major should be considered to have an increased risk of early vascular alteration and atherosclerosis. For this reason, common carotid artery intima-media thickness measurement can be recommended as a non-invasive and early diagnostic method.

Keywords

Beta-thalassaemia majorcarotid intima-media thicknesschildren
Type
Original Articles
Information
Cardiology in the Young , Volume 22 , Issue 1 , February 2012 , pp. 79 - 83
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Borgna-Pignatti, C, Rugolotto, S, De Stefano, P, et al. Survival and disease complications in thalassemia major. Ann N Y Acad Sci 1998; 850: 227–231.CrossRefGoogle ScholarPubMed
2. Cremastinos, DT. Heart failure in beta thalassaemia. Congest Heart Fail 2001; 7: 312–314.CrossRefGoogle Scholar
3. Kremastinos, DT, Flevari, P, Spyropoulou, M, Vrettou, H, Tsiapras, D, Stavropoulos-Giokas, CG. Association of heart failure in homozygous beta-thalassemia with the major histocompatibility complex. Circulation 1999; 100: 2074–2078.CrossRefGoogle ScholarPubMed
4. Aessopos, A, Farmakis, D, Loukopoulos, D. Elastic tissue abnormalities resembling pseudoxanthoma elasticum in beta thalassemia and the sickling syndromes. Blood 2002; 99: 30–35.CrossRefGoogle ScholarPubMed
5. Cheung, YF, Chan, GC, Ha, SY. Arterial stiffness and endothelial function in patients with beta-thalassemia major. Circulation 2002; 106: 2561–2566.CrossRefGoogle ScholarPubMed
6. Tsomi, K, Karagiorga-Lagana, M, Fragodimitri, C, Karabatsos, F, Katsiki, V. Arterial elastorrhexis: manifestation of a generalized elastic tissue disorder in beta-thalassaemia major. Eur J Haematol 1999; 63: 287–294.CrossRefGoogle ScholarPubMed
7. Cheung, YF, Chow, PC, Chan, GC, Ha, SY. Carotid intima-media thickness is increased and related to arterial stiffening in patients with beta-thalassaemia major. Br J Haematol 2006; 135: 732–734.CrossRefGoogle ScholarPubMed
8. Hahalis, G, Kremastinos, DT, Terzis, G, et al. Global vasomotor dysfunction and accelerated vascular aging in beta-thalassemia major. Atherosclerosis 2008; 198: 448–457.CrossRefGoogle ScholarPubMed
9. Aggeli, C, Antoniades, C, Cosma, C, et al. Endothelial dysfunction and inflammatory process in transfusiondependent patients with beta-thalassemia major. Int J Cardiol 2005; 105: 80–84.CrossRefGoogle ScholarPubMed
10. Day, SM, Duquaine, D, Mundada, LV, et al. Chronic iron administration increases vascular oxidative stress and accelerates arterial thrombosis. Circulation 2003; 107: 2601–2606.CrossRefGoogle ScholarPubMed
11. Eldor, A, Rachmilewitz, EA. The hypercoagulable state in thalassemia. Blood 2002; 99: 36–43.CrossRefGoogle ScholarPubMed
12. Kyriakou, DS, Alexandrakis, MG, Kyriakou, ES, et al. Activated peripheral blood and endothelial cells in thalassemia patients. Ann Hematol 2001; 80: 577–583.Google ScholarPubMed
13. Simon, A, Gariepy, J, Chironi, G, et al. Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk. J Hypertens 2002; 20: 159–169.CrossRefGoogle ScholarPubMed
14. Redberg, RF, Vogel, RA, Criqui, MH, et al. Task force 3 – what is the spectrum of current and emerging techniques for the noninvasive measurement of atherosclerosis. J Am Coll Cardiol 2003; 41: 1886–1898.CrossRefGoogle ScholarPubMed
15. Lorenz, MW, Markus, HS, Bots, ML, et al. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis. Circulation 2007; 115: 459–467.CrossRefGoogle ScholarPubMed
16. Pignoli, P, Tremoli, E, Poli, A, et al. Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging. Circulation 1986; 6: 1399–1406.CrossRefGoogle Scholar
17. Civilibal, M, Oflaz, H, Caliskan, S, et al. Left ventricular systolic and diastolic function and carotid intima-media thickness in pediatric dialysis patients. Int Urol Nephrol 2009; 41: 401–408.CrossRefGoogle ScholarPubMed
18. Peru, H, Altun, B, Dogan, M, Kara, F, Elmaci, AM, Oran, B. The evaluation of carotid intima-media thickness in children with familial Mediterranean fever. Clin Rheumatol 2008; 27: 689–694.CrossRefGoogle ScholarPubMed
19. Atabek, ME, Kurtoglu, S, Pirgon, O, et al. Arterial wall thickening and stiffening in children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2006; 74: 33–40.CrossRefGoogle ScholarPubMed
20. Tantawy, AAG, Adly, AAM, El Maaty, MGA, Amin, SAG. Subclinical atherosclerosis in young β-thalassemia major patients. Hemoglobin 2009; 33: 463–474.CrossRefGoogle ScholarPubMed
21. Limsuwan, A, Tubtom, D, Pakakasama, S, Chaunsumrit, A. Comparison of vascular complications between conventional treatment and bone marrow transplantation for children with β-thalassemia disease. Pediatr Cardiol 2009; 30: 777–780.CrossRefGoogle ScholarPubMed
22. Olivieri, NF. The beta-thalassemias. N Engl J Med 1999; 341: 99–109.CrossRefGoogle ScholarPubMed
23. Telfer, PT, Prestcott, E, Holden, S, Walker, M, Hoffbrand, AV, Wonke, B. Hepatic iron concentration combined with longterm monitoring of serum ferritin to predict complications of iron overload in thalassaemia major. Br J Haematol 2000; 110: 971–977.CrossRefGoogle ScholarPubMed
24. Borgna-Pignatti, C, Cappellini, MD, De Stefano, P, et al. Cardiac morbidity and mortality in deferoxamine-or deferiprone-treated patients with thalassemia major. Blood 2006; 107: 3733–3737.CrossRefGoogle ScholarPubMed
25. Salonen, JT, Nyyssonen, K, Korpela, H, Tuomilehto, J, Seppanen, R, Salonen, R. High stored iron levels are associated with excess risk of myocardial infarction in eastern Finnish men. Circulation 1992; 86: 803–811.CrossRefGoogle ScholarPubMed
26. Kiechl, S, Willeit, J, Egger, G, Poewe, W, Oberhollenzer, F. Body iron stores and the risk of carotid atherosclerosis: prospective results from the Bruneck study. Circulation 1997; 96: 3300–3307.CrossRefGoogle ScholarPubMed
27. Tuomainen, TP, Salonen, R, Nyyssönen, K, Salonen, JT. Cohort study of relation between donating blood and risk of myocardial infarction in 2,682 men in eastern Finland. BMJ 1997; 314: 793–794.CrossRefGoogle Scholar
28. Wolff, B, Volzke, H, Ludemann, J, et al. Association between high serum ferritin levels and carotid atherosclerosis in the study of health in Pomerania (SHIP). Stroke 2004; 35: 453–457.CrossRefGoogle ScholarPubMed
29. Syrovatka, P, Kraml, P, Hulikova, K, et al. Iron stores are associated with asymptomatic atherosclerosis in healthy men of primary prevention. Eur J Clin Invest 2011; 41: 846–853.CrossRefGoogle ScholarPubMed
30. Balla, G, Jacob, HS, Eaton, JW, Belcher, JD, Vercellotti, GM. Hemin: a possible physiological mediator of low-density lipoprotein oxidation and endothelial injury. Arterioscler Thromb 1991; 11: 1700–1711.CrossRefGoogle ScholarPubMed
31. Kunsch, C, Medford, RM. Oxidative stress as a regulator of gene expression in the vasculature. Circ Res 1999; 85: 753–766.CrossRefGoogle ScholarPubMed
32. Pratico, D, Pasin, M, Barry, OP, et al. Iron-dependent human platelet activation and hydroxyl radical formation: involvement of protein kinase C. Circulation 1999; 99: 3118–3124.CrossRefGoogle ScholarPubMed
33. Scaccabarozzi, A, Arosio, P, Weiss, G, et al. Relationship between TNF-alpha and iron metabolism in differentiating human monocytic THP-1 cells. Br J Haematol 2000; 110: 978–984.CrossRefGoogle ScholarPubMed
34. Schechter, AN, Gladwin, MT. Hemoglobin and the paracrine and endocrine functions of nitric oxide. N Engl J Med 2003; 348: 1483–1485.CrossRefGoogle ScholarPubMed
35. Bellocq, A, Israel-Biet, D, Cadranel, J, et al. Reduction of tumour necrosis factor alpha expression and signalling in peripheral blood mononuclear cells from patients with thalassaemia or sickle cell anaemia upon treatment with desferrioxamine. Cytokine 1999; 11: 168–172.CrossRefGoogle ScholarPubMed
36. Del Vecchio, GC, Schettini, F, Piacente, L, De Santis, A, Giordano, P, De Mattia, D. Effects of deferiprone on immune status and cytokine pattern in thalassaemia major. Acta Haematol 2002; 108: 144–149.CrossRefGoogle ScholarPubMed
37. Lombardi, G, Matera, R, Minervini, MM, et al. Serum levels of cytokines and soluble antigens in polytransfused patients with beta-thalassemia major: relationship to immune status. Haematologica 1994; 79: 406–412.Google ScholarPubMed