NT-proBNP levels in β-thalassemia major patients without cardiac hemosiderosis

Ayşegül Uğur Kurtoğlu 1 , 2 , Volkan Karakuş 3 , Erdal Kurtoğlu 4  and Selen Bozkurt 5
  • 1 Antalya Education and Research Hospital, Department of Biochemistry, Antalya 07050, Turkey
  • 2 Varlık Mah. Antalya Eğitim ve Araştırma Hastanesi Merkez Laboratuvarı, Turkey
  • 3 Education and Research Hospital, Department of Hematology, Sıtkı Koçman University, Muğla, Turkey
  • 4 Antalya Education and Research Hospital, Department of Hematology, Antalya, Turkey
  • 5 Faculty of Medicine, Department of Biostatistics Medical Informatics, Akdeniz University, Antalya, Turkey
Ayşegül Uğur Kurtoğlu, Volkan Karakuş, Erdal Kurtoğlu and Selen Bozkurt

Abstract

Introduction:

Heart failure due to hemosiderosis is frequent in beta-thalassemia major (β-TM) patients. Magnetic resonance imaging (MRI) is used in the early detection of heart failure. Amino-terminal pro-brain natriuretic peptide (NT-proBNP) is a very sensitive marker in the diagnosis of heart failure. In this study, we aimed to investigate the efficacy of NT-proBNP levels in thalassemia patients, who are thought to have no cardiac iron deposition according to T2* scoring system (CMRT2*>20 msn), in early identification of cardiac failure.

Methods:

NT-proBNP levels of 31 patients, who have T2*>20 ms, and of 25 healthy population were measured by chemoluminescence method.

Results:

NT-proBNP levels were not different in thalassemic patients [median: 33 (IQR: 28–94) pg/mL] compared to control group [median: 41 (IQR: 28–59) pg/mL]. We found that NT-proBNP level was above cut-off value in six patients.

Conclusion:

NT-proBNP is a cheaper, reachable, and noninvasive method compared to MRI technique, it can be easily used in monthly controls. Detection of high NT-proBNP levels above cut-off values in patients whose T2* values are normal indicates that measurement of NT-pro-BNP is a more sensitive marker in early detection of cardiac failure.

  • 1.

    Hershko C. Iron loading and its clinical implications. Am J Hematol 2007;82:1147–8.

    • Crossref
    • PubMed
    • Export Citation
  • 2.

    Pennell DJ, Udelson JE, Arai AE, Bozkurt B, Cohen AR, Galanello R, et al. Cardiovascular function and treatment in β-thalassemia major: a consensus statement from the American Heart Association. Circulation 2013;128:281–308.

    • Crossref
    • PubMed
    • Export Citation
  • 3.

    Hahalis G, Alexopoules D, Kremastinos DT, Zoumbos NC. Heart failure in B-thalassemia syndromes: a decade of progress. Am J Med 2005;118:957–67.

    • Crossref
    • Export Citation
  • 4.

    Dessì C, Leoni G, Moi P, Danjou F, Follesa I, Foschini ML, et al. Thalassemia major between liver and heart: Where we are now. Blood Cells Mol Dis 2015;55:82–8.

    • Crossref
    • PubMed
    • Export Citation
  • 5.

    Kremastinos DT, Tsetsos GA, Tsiapras DP, Karavolias GK, Ladis VA, Kattamis CA. Heart failure in beta thalassemia: a 5-year follow-up study. Am J Med 2001;111:349–54.

    • Crossref
    • PubMed
    • Export Citation
  • 6.

    Kirk P, Roughton M, Porter JB, Walker JM, Tanner MA, Patel J, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation 2009;120:1961–8.

    • Crossref
    • PubMed
    • Export Citation
  • 7.

    He T. Cardiovascular magnetic resonance T2* for tissue iron assessment in the heart. Quant Imaging Med Surg 2014;4:407–12.

    • PubMed
    • Export Citation
  • 8.

    Bhardwai A, Januzzi JL Jr. Natriuretic peptide-guided management of acutely destabilized heart failure: rationale and treatment algorithm. Crit Pathw Cardiol 2009;8:146–50.

    • Crossref
    • PubMed
    • Export Citation
  • 9.

    Kremastinos DT, Hamodraka E, Parissis J, Tsiapras D, Dima K, Maisel A. Predictive value of B-type natriuretic peptides in detecting latent left ventricular diastolic dysfunction in beta-thalassemia major. Am Heart J 2010;159:68–74.

    • Crossref
    • PubMed
    • Export Citation
  • 10.

    Magri D, Sciomer S, Fedele F, Gualdi G, Casciani E, Pugliese P, et al. Early impairment of myocardial function in young patients with beta-thalassemia major. Eur J Haematol. 2008;80:515–22.

    • Crossref
    • Export Citation
  • 11.

    Said Othman KM, Elshazly SA, Heiba NM. Role of non-invasive assessment in prediction of preclinical cardiac affection in multi-transfused thalassaemia major patients. Hematology 2014;19:380–7.

    • Crossref
    • PubMed
    • Export Citation
  • 12.

    Quinn CT, St Pierre TG. MRI Measurements of Iron load in transfusion-dependent patients: implementation, challenges, and pitfalls. Pediatr Blood Cancer 2015;63:773–80.

    • PubMed
    • Export Citation
  • 13.

    Modell B, Khan M, Darlison M, Westwood MA, Ingram D, Pennell DJ. Improved survival of thalassaemia major in the UK and relation to T2* cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2008;10:42.

    • Crossref
    • PubMed
    • Export Citation
  • 14.

    Palazzuoli A, Gallotta M, Quatrini I, Nuti R. Natriuretic peptides (BNP and NT-proBNP): measurement and relevance in heart failure. Vasc Health Risk Manag 2010;6:411–8.

    • PubMed
    • Export Citation
  • 15.

    Kostopoulou AG, Tsiapras DP, Chaidaroglou AS, De Giannis DE, Farmakis D, Kremastinos DT. The pathophysiological relationship and clinical significance of left atrial function and left ventricular diastolic dysfunction in β-thalassemia major. Am J Hematol 2014;89:13–8.

    • Crossref
    • PubMed
    • Export Citation
  • 16.

    Delaporta P, Kattamis A, Apostolakou F, Bolu S, Bartzeliotou A, Tsoukas E, et al. Correlation of NT-proBNP levels and cardiac iron concentration in patients with transfusion-dependent thalassemia major. Blood Cells Mol Dis 2013;50:20–4.

    • Crossref
    • PubMed
    • Export Citation
  • 17.

    Balkan C, Tuluce SY, Basol G, Tuluce K, Ay Y, Karapinar DY, et al. Relation between NT-proBNP levels, iron overload, and early stage of myocardial dysfunction in β-thalassemia major patients. Echocardiography 2012;29:318–25.

    • Crossref
    • PubMed
    • Export Citation
  • 18.

    Pennell DJ. T2* magnetic resonance and myocardial iron in thalassemia. Ann N Y Acad Sci 2005;1054:373–8.

    • Crossref
    • PubMed
    • Export Citation
  • 19.

    Mayo Medical Laboratories. NT-Pro B-Type Natriuretic Peptide (BNP), Serum. http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/84291. Accessed: Sept. 2016.

  • 20.

    Mehrzad V, Khajouei AS, Fahami E. Correlation of N-terminal pro-B-type natriuretic peptide levels and cardiac magnetic resonance imaging T2* in patients with ß-thalassaemia major. Blood Transfus 2016;14:516–20.

  • 21.

    Casale M, Meloni A, Filosa A, Cuccia L, Caruso V, Palazzi G, et al. Multiparametric cardiac magnetic resonance survey in children with thalassemia Major: a multicenter study. Circ Cardiovasc Imaging 2015;8:e003230.

    • PubMed
    • Export Citation
Purchase article
Get instant unlimited access to the article.
$42.00
Log in
Already have access? Please log in.


or
Log in with your institution

Journal + Issues

Turkish Journal of Biochemistry (TJB), official journal of Turkish Biochemical Society, is issued electronically every 2 months. The main aim of the journal is to support the research and publishing culture by ensuring that every published manuscript has an added value and thus providing international acceptance of the “readability” of the manuscripts published in the journal.

Search