Gender differences in the development of cardiac complications: a multicentre study in a large cohort of thalassaemia major patients to optimize the timing of cardiac follow-up.

Publisher: Wiley-Blackwell Country of Publication: England NLM ID: 0372544 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2141 (Electronic) Linking ISSN: 00071048 NLM ISO Abbreviation: Br J Haematol Subsets: MEDLINE

Publication: Oxford : Wiley-Blackwell
Original Publication: Oxford : Blackwell Scientific Publications

Arrhythmias, Cardiac*/diagnostic imaging ; Arrhythmias, Cardiac*/etiology ; Arrhythmias, Cardiac*/metabolism ; Arrhythmias, Cardiac*/mortality ; Heart Failure*/diagnostic imaging ; Heart Failure*/etiology ; Heart Failure*/metabolism ; Heart Failure*/mortality ; Magnetic Resonance Imaging* ; Sex Characteristics* ; Ventricular Dysfunction*/diagnostic imaging ; Ventricular Dysfunction*/etiology ; Ventricular Dysfunction*/metabolism ; Ventricular Dysfunction*/mortality; Adult ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Iron/metabolism ; Male ; Survival Rate ; beta-Thalassemia/diagnostic imaging ; beta-Thalassemia/metabolism ; beta-Thalassemia/mortality ; beta-Thalassemia/therapy

We assessed whether male gender was associated with a higher risk of cardiac iron accumulation and fibrosis, heart dysfunction and complications in a large, multicentre cohort of thalassaemia major (TM) patients, in order to optimize the timing in cardiac follow-up. We considered 1711 TM patients (899 females, 31·09 ± 9·08 years), enrolled in the Myocardial Iron Overload in Thalassaemia Network. Clinical/instrumental data are recorded from birth to the first Cardiovascular Magnetic Resonance Imaging scan. Although having a similar risk of accumulating iron, males showed a significantly higher risk of developing cardiac dysfunction, heart failure, arrhythmias and cardiac complications overall, when compared to females (P < 0·0001). Up to 20-30 years of follow-up, the Kaplan-Meier curves for the outcomes for which the male sex was a significant prognosticator almost overlapped, whereas they clearly diverged after this period. In patients with follow-up longer than 20 years, males exhibited a significantly higher risk of ventricular dysfunction, heart failure, arrhythmias, and cardiac complications. Female patients may have an intrinsically better tolerance for iron toxicity. International guidelines suggest annual cardiac evaluation for thalassaemia patients. It is possible that female patients can be evaluated at longer intervals, thus reducing health costs.
(© 2018 John Wiley & Sons Ltd.)

Keywords: cardiac complications; cardiac follow-up; gender; thalassaemia major

E1UOL152H7 (Iron)

Date Created: 20180306 Date Completed: 20190205 Latest Revision: 20190215

20221213

10.1111/bjh.15125

29504129