Iranian Heart Journal

Iranian Heart Journal

Relationship Between the Plasma Levels of Vitamin D and Magnesium and Cardiac Involvement and Iron Overload in Thalassemia Major Patients Referred to Ganjavian Hospital of Dezful in 2018

Document Type : Original Article

Authors
Hakimeh Saadatifar 1
Hediyeh Mohaghegh 1
Maryam Ahmadi 1
Mayam Moshkani farahani 2
1 Department of Medicine, Dezful University of Medical Sciences, Dezful, IR Iran.
2 Atherosclerosis Research Center, Baqiayatallah University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Thalassemia is a hematologic and genetic disorder prevalent both in Iran and the world. As these patients receive frequent transfusions, they are exposed to iron overload in different tissues such as the liver and the heart. Vitamin D and magnesium deficiencies have been known as important risk factors for cardiovascular diseases. We studied the association between the plasma levels of vitamin D and magnesium and different levels of heart involvement in thalassemia major patients.
 
Methods: Sampling was performed by the convenience method based on the inclusion/exclusion criteria of the study. Patients’ data, including age, sex, vitamin D plasma levels, magnesium plasma levels, cardiac iron overload based on MRI T2*, echocardiographic information, and electrocardiographic (ECG) information, were collected.
 
Results: In this study, 43 patients, composed of 20 men (46.5%) and 23 women (53.5%) at a mean age of 31.35±7.03 years were examined. In total, 39.5% and 27/9% of them had abnormal echocardiography and ECG. Maximum cardiac abnormalities observed in echocardiography were related to left ventricular diastolic dysfunction (23.3%), right ventricular enlargement (9%), reduced left ventricular ejection fractions (9%), and more-than-mild tricuspid valve regurgitation (9%). Moreover, a reduction in the magnesium plasma level was associated with an increase in the number of cardiac abnormalities in echocardiography significantly (P<0.05). There was a significant relationship between echocardiography and ECG results.
 
Conclusions: Considering the inverse relationship between the plasma levels of vitamin D and magnesium and cardiac iron overload, we recommend that the plasma level of vitamin D and magnesium be checked periodically in these patients. (Iranian Heart Journal 2021; 22(4): 15-24)
Keywords
Iron
Thalassemia
Vitamin D
Magnesium
Heart disease
  1. Soteh H, Akhavan Niaki H, Kowsarian M, Aliasgharian A, Banihashemi A. Frequency of Beta-globin gene mutations in beta-thalassemia patients from east of Mazandaran. Journal of Mazandaran University of Medical Sciences. 2008; 18(67):17-25.
  2. Cappellini M-D, Cohen A, Porter J, Taher A, Viprakasit V. Guidelines for the management of transfusion dependent thalassaemia (TDT): Thalassaemia International Federation Nicosia, Cyprus; 2014.
  3. Rund D, Rachmilewitz E. β-Thalassemia. New England Journal of Medicine. 2005;353(11):1135-46.
  4. Giambona A, Passarello C, Vinciguerra M, Muli RL, Teresi P, Anzà M, et al. Significance of borderline hemoglobin A2 values in an Italian population with a high prevalence of β-thalassemia. haematologica. 2008; 93(9):1380-4.
  5. Firouzbakhtkh S, Ghasemi K, Motamed N, Sarrikhani M. The Evaiuation of chalator therapy in reducing serum ferritin and improving Ejection fraction (EF%) in thalassemic patients. ISMJ. 2015;18(2):280-7.
  6. Britton RS, Leicester KL, Bacon BR. Iron toxicity and chelation therapy. International journal of hematology. 2002;76(3):219-28.
  7. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics—2011 update. Circulation. 2011;123(4):e18-e209.
  8. Galanello R, Origa Beta-thalassemia. Orphanet journal of rare diseases. 2010;5(1):11.
  9. Bradai M, Pissard S, Abad MT, Dechartres A, Ribeil JA, Landais P, et al. Decreased transfusion needs associated with hydroxyurea therapy in Algerian patients with thalassemia major or intermedia. Transfusion. 2007;47(10):1830-6.
  10. Ghugre NR, Enriquez CM, Gonzalez I, Nelson MD, Coates TD, Wood JC. MRI detects myocardial iron in the human heart. Magnetic resonance in medicine. 2006;56(3):681-6.
  11. Mavrogeni SI, Markussis V, Kaklamanis L, Tsiapras D, Paraskevaidis I, Karavolias G, et al. A comparison of magnetic resonance imaging and cardiac biopsy in the evaluation of heart iron overload in patients with β‐thalassemia major. European journal of haematology. 2005;75(3):241-7.
  12. Maleki E, Daei MH, Frahmandi nia Z, Ebrahimi P. The Relationship between Plasma Level of 25-Hydroxy vitamin D3 and Plasma Ferritin Level in Children with Thalassemia Major. Afzalipour Journal of Clinical Research. 2016;1(1):9-18.
  13. Bonakdaran S, Varasteh A, Khaajeh-Dalouie M. Serum 25 Hydroxy Vitamin D3 and Laboratory Risk Markers of Cardiovascular Diseases in Type 2 Diabetic Patients. Iranian Journal of Endocrinology and Metabolism. 2010;11(5):504-9.
  14. Deleskog A, Ostenson C. Vitamin D and Aspects of Cardiovascular Disease. J Diabetes Metab. 2015;6(545):2.
  15. Soliman A, De Sanctis V, Adel A, El Awwa A, Bedair S. Clinical, biochemical and radiological manifestations of severe vitamin d deficiency in adolescents versus children: response to therapy. Georgian medical news. 2012(210):58-64.
  16. De Baaij JH, Hoenderop JG, Bindels RJ. Magnesium in man: implications for health and disease. Physiological reviews. 2015;95(1):1-46.
  17. Ishimura E, Okuno S, Yamakawa T, Inaba M, Nishizawa Y. Serum magnesium concentration is a significant predictor of mortality in maintenance hemodialysis patients. Magnesium Research. 2007;20(4):237-44.
  18. Bernardini D, Nasulewicz A, Mazur A, Maier J. Magnesium and microvascular endothelial cells: a role in inflammation and angiogenesis. Front Biosci. 2005;10:1177-82.
  19. Maier JA, Malpuech-Brugère C, Zimowska W, Rayssiguier Y, Mazur A. Low magnesium promotes endothelial cell dysfunction: implications for atherosclerosis, inflammation and thrombosis. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease. 2004;1689(1):13-21.
  20. Kramer JH, Mak IT, Phillips TM, Weglicki WB. Dietary magnesium intake influences circulating pro-inflammatory neuropeptide levels and loss of myocardial tolerance to postischemic stress. Experimental Biology and Medicine. 2003;228(6):665-73.
  21. Kramer JH, Mak I-T, Tejero-Taldo MI, Chmielinska JJ, Komarov AM, Tziros C, et al. Neurogenic inflammation and cardiac dysfunction due to hypomagnesemia. The American journal of the medical sciences. 2009; 338(1):22-7.
  22. Angastiniotis M, Modell B. Global epidemiology of hemoglobin disorders. Annals of the New York Academy of Sciences. 1998 Jun; 850(1):251-69.
  23. Bazregar M, Peiravian F, Karimi M, Fathzadeh M. Correlation between left ventricular dysfunction with hematological parameters and Iron chelation in β-thalassemia major. Journal of Medical Research. 2004;3(1):48-57.
  24. Kiani AA, Mortazavi Y, Zeinali S, Shirkhani The molecular analysis of β-thalassemia mutations in Lorestan Province, Iran. Hemoglobin. 2007;31(3):343-9.
  25. Jafari H, Vahidshahi K, Kosaryan M, Karami H, Reza Mahdavi M, Ehteshami S. Major beta-thalassemia, use of desferiexamine and renal proximal tubular damage. Bratisl Lek Listy. 2011;112(5):278-81.
  26. Hashemieh M, Javadzadeh M, Shirkavand A, Sheibani K. Lipid profile in minor thalassemic patients: a historical cohort study. Bangladesh Medical Research Council Bulletin. 2011;37(1):24-7.
  27. Chahkandi T, Kazemi T, Jalili A, Ghaderi F. Evaluation of cardiac function in patients with major beta thalassemia in Birjand. The Scientific Journal of Iranian Blood Transfusion Organization. 2013;10(1):86-92.
  28. Malakan Rad A, Momtazmanesh N. Study of cardiac complications in patients with major thalassemia in Kashan, during 1999-2000. Razi Journal of Medical Sciences. 2002;8(27):623-31.
  29. Russo V, Melillo E, Papa AA, Rago A, Chamberland C, Nigro G. Arrhythmias and Sudden Cardiac Death in Beta-Thalassemia Major Patients: Noninvasive Diagnostic Tools and Early Markers. Cardiology Research and Practice. 2019;2019.
  30. Faruqi AF. Electrocardiographic Changes in Thalassemia Major Patients and their Association with Serum Ferritin Levels. Journal of Rawalpindi Medical College. 2015;19(3):185-8.
  31. Kaye S, Owen M. Cardiac arrhythmias in thalassaemia major: evaluation of chelation treatment using ambulatory monitoring. British medical journal. 1978;1(6109):342.
  32. Kremastinos DT, Tsetsos GA, Tsiapras DP, Karavolias GK, Ladis VA, Kattamis CA. Heart failure in beta thalassemia: a 5-year follow-up study. The American journal of medicine. 2001;111(5):349-54
  33. Koonrungsesomboon N, Chattipakorn SC, Fucharoen S, Chattipakorn N. Early detection of cardiac involvement in thalassemia: From bench to bedside perspective. World journal of cardiology. 2013 Aug 26;5(8):270.
  34. Oztarhan K, Delibas Y, Salcioglu Z, Kaya G, Bakari S, Bornaun H, et al. Assessment of cardiac parameters in evaluation of cardiac functions in patients with thalassemia major. Pediatric hematology and oncology. 2012;29(3):220-34.
  35. Wang L, Manson JE, Song Y, Sesso HD. Systematic review: vitamin D and calcium supplementation in prevention of cardiovascular events. Annals of internal medicine. 2010;152(5):315-23.
  36. Wood JC, Claster S, Carson S, Menteer J, Hofstra T, Khanna R, et al. Vitamin D deficiency, cardiac iron and cardiac function in thalassaemia major. British journal of haematology. 2008;141(6):891-4.
  37. Parva NR, Tadepalli S, Singh P, Qian A, Joshi R, Kandala H, et al. Prevalence of vitamin D deficiency and associated risk factors in the US population (2011-2012). Cureus. 2018;10(6).
  38. Maleki E, Daei MH, Ebrahimi P. The Relationship between Plasma Level of 25-Hydroxy vitamin D3 and Plasma Ferritin Level in Children with Thalassemia Major. Afzalipour Journal of Clinical Research. 2016.
  39. Mehrabi G, Salehi M. Evaluation of Prevalence of ventricular tachyarrhythmia in patients with acute myocardial infarction and serum magnesium in Khatam-Al-Anbia Hospital, Zahedan, Iran. Zahedan Journal of Research in Medical Sciences. 2006;8(2).
  40. Mirmohammadi F, Derakhshanfar H, Kariman H, Alavi Moghaddam Tehrani M, Hatamabadi H, Shahrami A, et al. Association between Serum Magnesium Level and Cardiac Arrhythmia in Patients with Acute Coronary Syndromes. Journal of Babol University Of Medical Sciences. 2013; 15(3):36-41.
  41. Solaiman H, Kazemi T. The serum magnesium level in patients with congestive heart failure. Med J Mashhad Univ Med Sci. 2006; 90(48):399-404.
  42. Al-Samarrai AH, Adaay MH, Al-Tikriti KA, Al-Anzy MM. Evaluation of some essential element levels in thalassemia major patients in Mosul district, Iraq. Saudi medical journal. 2008; 29(1):94-7.
  43. Karim MF, Ismail M, Hasan AM, Shekhar HU. Hematological and biochemical status of Beta-thalassemia major patients in Bangladesh: A comparative analysis. International journal of hematology-oncology and stem cell research. 2016; 10(1):7.
  44. DiNicolantonio JJ, O’Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis. Open heart. 2018; 5(1):e000668.
Iranian Heart Journal
Volume 22, Issue 4
Autumn 2021
Pages 15-24