Epidemiologic as well as clinical studies confirm a close link between diabetes mellitus (DM) and heart failure (HF) in the general population. In a retrospective historical thalassemia major (TM) cohort, DM was demonstrated to lead to an higher frequency of cardiac complications also independently of cardiac iron status, but not prospective data are available. So, we determined prospectively the predictive value of DM for HF, arrhythmias and cardiac complications (HF, arrhythmias and pulmonary hypertension) in TM. We followed prospectively 537 patients enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. Fifty-six patients were excluded because a cardiac complication was present at the time of the first Cardiovascular Magnetic Resonance (CMR), representing our starting point. All the considered 481 TM patients were white (29.48±8.93 years, 263 females). Mean follow-up was 57.91±18.23 months. DM was present in the 9.8% of patients. Cardiac events were recorded in 36 patients (7.5%). There were 18 episodes of HF, 16 arrhythmias and 2 pulmonary hyperthension. DM was a significant predictive factor for HF (hazard ratio-HR=5.62, 95%CI=2.08-15.22; P<0.0001) as well as for arrhythmias (HR=3.70, 95%CI=1.18-11.65; P=0.025) and for cardiac complications globally considered (HR=4.26, 95%CI=2.04-8.92; P<0.0001). DM remained a significant prognosticator for HF and cardiac complications also in a multivariate model including cardiac iron. In conclusion, DM was found to be a strong predictor for HF, arrhythmias and cardiac complications. Our findings are relevant for the prevention of glucose disorder metabolism and they stress the need to intensify the chelation therapy in patients in whom excess pancreatic iron is found by MR, where available, or when patients develop glucose metabolism disorders.
The Prognostic Role of Diabetes Mellitus for Cardiac Complications in a Large Cohort of Well Treated Thalassemia Major Patients
Rossi Giuseppe;
2014
Abstract
Epidemiologic as well as clinical studies confirm a close link between diabetes mellitus (DM) and heart failure (HF) in the general population. In a retrospective historical thalassemia major (TM) cohort, DM was demonstrated to lead to an higher frequency of cardiac complications also independently of cardiac iron status, but not prospective data are available. So, we determined prospectively the predictive value of DM for HF, arrhythmias and cardiac complications (HF, arrhythmias and pulmonary hypertension) in TM. We followed prospectively 537 patients enrolled in the Myocardial Iron Overload in Thalassemia (MIOT) network. Fifty-six patients were excluded because a cardiac complication was present at the time of the first Cardiovascular Magnetic Resonance (CMR), representing our starting point. All the considered 481 TM patients were white (29.48±8.93 years, 263 females). Mean follow-up was 57.91±18.23 months. DM was present in the 9.8% of patients. Cardiac events were recorded in 36 patients (7.5%). There were 18 episodes of HF, 16 arrhythmias and 2 pulmonary hyperthension. DM was a significant predictive factor for HF (hazard ratio-HR=5.62, 95%CI=2.08-15.22; P<0.0001) as well as for arrhythmias (HR=3.70, 95%CI=1.18-11.65; P=0.025) and for cardiac complications globally considered (HR=4.26, 95%CI=2.04-8.92; P<0.0001). DM remained a significant prognosticator for HF and cardiac complications also in a multivariate model including cardiac iron. In conclusion, DM was found to be a strong predictor for HF, arrhythmias and cardiac complications. Our findings are relevant for the prevention of glucose disorder metabolism and they stress the need to intensify the chelation therapy in patients in whom excess pancreatic iron is found by MR, where available, or when patients develop glucose metabolism disorders.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
