Risk Factors Associated With Heart Failure in Patients With β-Thalassemia

Document Type : Original Article


1 Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.

2 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

3 Management Center for Transplantation and Special Diseases, Ministry of Health, IR Iran.

4 Tehran University of Medical Sciences, Thrombosis and Hemostasis Research Center, Tehran, IR Iran.

5 Department of Pediatric Hematology-Oncology, Mofid Childeren' s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.


Background: Inherited hemoglobin disorders such as thalassemia are among the most critical public health concerns. Heart failure (HF) is one of the essential complications in β-thalassemia patients. Cardiac iron accumulation is the single greatest risk factor for cardiac dysfunction in thalassemia. Our study aimed to determine factors associated with HF in β-thalassemia patients.
Methods: This was a retrospective cohort study on 2913 patients with thalassemia. Thorough medical history taking and physical examinations were done for a basic cardiac assessment, including 12-lead electrocardiography and detailed echocardiography, according to the guidelines. Cardiac magnetic resonance imaging was used to evaluate cardiac iron overload (T2), which was an invaluable tool to estimate the clinical risk and the development of heart complications in the patients. A logistic regression model was used in SPSS, version 23.0, to assess HF factors. The Hosmer–Lemeshow test and ROC curve were used for goodness of fit.
Results: Overall, 14.69% of the patients had HF. The logistic regression model showed that thalassemia major, older age, higher hemoglobin, higher ferritin, later initiation, iron chelators, more blood transfusion, and comorbidities increased the risk of HF in thalassemia patients. The adjusted area under the ROC curve in the logistic regression model was 0.79.
Conclusions: Most factors related to an increased risk of HF in thalassemia patients were controllable. The timely onset of transfusions and iron chelator therapy, as well as long-life follow-up, can help detect cardiac involvement and treat the disease early. (Iranian Heart Journal 2022; 23(3): 88-96)


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