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Pulmonary Artery Hypertension in Transfusion-Dependent Thalassemia

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Abstract

Objective

Patients with transfusion-dependent thalassemia (TDT) are at risk of developing pulmonary artery hypertension (PAH) due to chronic hemolysis, iron overload, hypercoagulability and splenectomy. The objective of the study was to assess the prevalence and predictors of PAH in patients with TDT.

Methods

Patients aged 6–18 years with TDT were included. 2D-echocardiography was done to measure the pulmonary artery systolic pressure (PASP) and left ventricular ejection fraction (LVEF). T2* MRI was done to evaluate cardiac iron overload. N-terminal-pro brain natriuretic peptide (NT-pro BNP) level was also assessed.

Results

Out of 60 participants, PAH was noted in 19 (31.6%). Mean (SD) age of the patients with PAH and without PAH was 12.2 (3.8) and 9.6 (3.5) years, respectively (P = 0.016). Five of 19 patients with PAH (26.3%) had undergone splenectomy as against 5 of 41 patients without PAH (12.2%) (P = 0.17). Years since splenectomy was higher in the PAH group. Mean (SD) NT-Pro BNP levels were also higher in patients with PAH [63.80 (25.89) vs 41.97 (23.95), P = 0.01]. Significantly higher number of patients with PAH had cardiac T2* value of < 10 ms (P = 0.04). Age (OR 4.11; 95% CI 1.46–8.77), years since splenectomy (OR 3.24; 95% CI 1.30–7.86), NT-Pro BNP levels (OR 4.43; 95% CI 2.14–9.60) and cardiac T2* MRI (OR 2.46; 95% CI 2.18–6.90) values were predictors of PAH in patients with TDT.

Conclusion

PAH was observed in 31.6 % of patients, with older age and years since splenectomy being important risk factors. NT-Pro BNP can be used as screening test for detecting PAH.

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Funding

Funding: None

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Authors and Affiliations

  1. Division of Pediatric Hematology Oncology, Department pf Pediatrics, Institute of Medical Sciences, Banaras Hindu University (BHU), Varanasi, Uttar Pradesh, India

    Vineeta Gupta, Vishnu Vijayakumar & Priyanka Aggarwal

  2. Department of Radiodiagnosis, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

    Ishan Kumar

  3. Department of Cardiology, Institute of Medical Sciences, BHU, Varanasi, Uttar Pradesh, India

    Vikas Agrawal

Authors
  1. Vineeta Gupta
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  2. Vishnu Vijayakumar
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  3. Priyanka Aggarwal
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  4. Ishan Kumar
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  5. Vikas Agrawal
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Contributions

Contributors: VG conceptualized and wrote the article. VV and PA collected the data, IK analyzed the MRI results, VA helped in cardiac evaluation. All authors approved the final manuscript and are accountable.

Corresponding author

Correspondence to Vineeta Gupta.

Ethics declarations

Ethic clearance: Dean/2019/EC/1756 dated 18.11.2019.

Competing interests: None stated.

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Gupta, V., Vijayakumar, V., Aggarwal, P. et al. Pulmonary Artery Hypertension in Transfusion-Dependent Thalassemia. Indian Pediatr 61, 49–52 (2024). https://doi.org/10.1007/s13312-024-3087-2

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  • DOI: https://doi.org/10.1007/s13312-024-3087-2

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