Τίτλος:
Effect of deferiprone or deferoxamine on right ventricular function in
thalassemia major patients with myocardial iron overload
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: Thalassaemia major (TM) patients need regular blood
transfusions that lead to accumulation of iron and death from heart
failure. Deferiprone has been reported to be superior to deferoxamine
for the removal of cardiac iron and improvement in left ventricular (LV)
function but little is known of their relative effects on the right
ventricle (RV), which is being increasingly recognised as an important
prognostic factor in cardiomyopathy. Therefore data from a prospective
randomised controlled trial (RCT) comparing these chelators was
retrospectively analysed to assess the RV responses to these drugs.
Methods: In the RCT, 61 TM patients were randomised to receive either
deferiprone or deferoxamine monotherapy, and CMR scans for T2* and
cardiac function were obtained. Data were re-analysed for RV volumes and
function at baseline, and after 6 and 12 months of treatment.
Results: From baseline to 12 months, deferiprone reduced RV end systolic
volume (ESV) from 37.7 to 34.2 mL (p = 0.014), whilst RV ejection
fraction (EF) increased from 69.6 to 72.2% (p = 0.001). This was
associated with a 27% increase in T2* (p < 0.001) and 3.1% increase
in LVEF (p < 0.001). By contrast, deferoxamine showed no change in RVESV
(38.1 to 39.1 mL, p = 0.38), or RVEF (70.0 to 69.9%, p = 0.93) whereas
the T2* increased by 13% (p < 0.001), but with no change in LVEF
(0.32%; p = 0.66). Analysis of between drugs treatment effects, showed
significant improvements favouring deferiprone with a mean effect on
RVESV of-1.82 mL (p = 0.013) and 1.16% for RVEF (p = 0.008). Using
regression analysis the improvement in RVEF at 12 months was shown to be
greater in patients with lower baseline EF values (p < 0.001), with a
significant difference in RVEF of 3.5% favouring deferiprone over
deferoxamine (p = 0.012).
Conclusion: In this retrospective analysis of a prospective RCT,
deferiprone monotherapy was superior to deferoxamine for improvement in
RVEF and end-systolic volume. This improvement in the RV volumes and
function may contribute to the improved cardiac outcomes seen with
deferiprone.
Συγγραφείς:
Smith, Gillian C.
Alpendurada, Francisco
Carpenter, John Paul
and Alam, Mohammed H.
Berdoukas, Vasili
Karagiorga, Markissia
and Ladis, Vasili
Piga, Antonio
Aessopos, Athanassios and
Gotsis, Efstathios D.
Tanner, Mark A.
Westwood, Mark A. and
Galanello, Renzo
Roughton, Michael
Pennell, Dudley J.
Περιοδικό:
Journal of Cardiovascular Magnetic Resonance
DOI:
10.1186/1532-429X-13-34
