β-Thalassemia minor (β-Τm) is associated with rheological and biochemical alterations that can affect cardiovascular function. We aimed to evaluate the elastic arterial properties and the pulse wave augmentation indices in a population of patients with β-Τm. Seventy-five individuals with β-Τm (age 55.5 [42.75-65.25], women 48%) and 127 controls (age 57 years [48-63], women 55.1%) underwent comprehensive echocardiographic evaluation and applanation tonometry of the radial and femoral artery. Pulse wave analysis revealed that augmentation pressure, augmentation index (AIx), and heart rate–corrected AIx were significantly lower (median [interquartile range]: 8.75 [4.625-13] vs 11 [6.5-14.5], P = .017; 26.5 [17.5-33.375] vs 30.5 [20.75-37.5], P = .014; and 22.25 [15.125-29.5] vs 27 [20.5-33], P = .008, respectively) in the β-Τm group compared to controls. The left atrial active emptying volume was significantly lower and the isovolumic relaxation time was shorter in the β-Τm group compared to the control group (10.2 [7.4-14.4] vs 12.0 [8.6-15.8], P = .040 and 78 [70-90] vs 90 [70-104], P = .034, respectively). β-Thalassemia minor is associated with favorable pulse wave augmentation indices and left ventricular diastolic function profile in asymptomatic individuals with cardiovascular risk factors.
FlintJHardingRMBoyceAJCleggJB. The population genetics of the haemoglobinopathies. Baillieres Clin Haematol. 1998;11(1):1–51.
3.
ModellBDarlisonMBirgensH. Epidemiology of haemoglobin disorders in Europe: an overview. Scand J Clin Lab Invest. 2007;67(1):39–69.
4.
MatsaniotisNKattamisC. Thalassemias, a social problem in Greece. Ann Soc Belges Med Trop Parasitol Mycol. 1969;49(3):223–230.
5.
KalleasCAnagnostopoulosKSinopoulouK. Phenotype and genotype frequency of beta-thalassemia and sickle cell disease carriers in Halkidiki, Northern Greece. Hemoglobin. 2012;36(1):64–72.
6.
LaiMEVacquerSCartaMP. Evidence for a proatherogenic biochemical phenotype in beta thalassemia minor and intermedia. Acta Haematol. 2011;126(2):87–94.
7.
SelekSAslanMHorozMGurMErelO. Oxidative status and serum PON1 activity in beta-thalassemia minor. Clin Biochem. 2007;40(5-6):287–291.
8.
KarimiMBorhani HaghighiAYazdaniMRaisiHGitiRNamazeeMR. Is beta-thalassemia trait a protective factor against ischemic cerebrovascular accidents?J Stroke Cerebrovasc Dis. 2008;17(2):79–81.
9.
TassiopoulosSDeftereosSKonstantopoulosK. Does heterozygous beta-thalassemia confer a protection against coronary artery disease?Ann N Y Acad Sci. 2005;1054:467–470.
10.
LevisianouDFoussasSSkopelitisE. Arterial stiffness predicts risk for long-term recurrence in patients with type 2 diabetes admitted for acute coronary event. Diabetes Res Clin Pract. 2013;99(3):315–320.
11.
RowleyPT. The diagnosis of beta-thalassemia trait: a review. Am J Hematol. 1976;1(1):129–137.
12.
TakazawaKO’RourkeMFFujitaM. Estimation of ascending aortic pressure from radial arterial pressure using a generalised transfer function. Z Kardiol. 1996;85(suppl 3):137–139.
13.
AbhayaratnaWPBarnesMEO’RourkeMF. Relation of arterial stiffness to left ventricular diastolic function and cardiovascular risk prediction in patients > or =65 years of age. Am J Cardiol. 2006;98(10):1387–1392.
Van BortelLMLaurentSBoutouyrieP. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens. 2012;30(3):445–448.
16.
LangRMBierigMDevereuxRB. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–1463.
17.
DevereuxRBAlonsoDRLutasEM. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol. 1986;57(6):450–458.
18.
TeichholzLEKreulenTHermanMVGorlinR. Problems in echocardiographic volume determinations: echocardiographic-angiographic correlations in the presence of absence of asynergy. Am J Cardiol. 1976;37(1):7–11.
19.
FountoulakiKDimopoulosVGiannakoulisJZintzarasETriposkiadisF. Left ventricular mass and mechanics in mild-to-moderate hypertension: effect of nebivolol versus telmisartan. Am J Hypertens. 2005;18(2 pt 1):171–177.
20.
ShimizuGZileMRBlausteinASGaaschWH. Left ventricular chamber filling and midwall fiber lengthening in patients with left ventricular hypertrophy: overestimation of fiber velocities by conventional midwall measurements. Circulation. 1985;71(2):266–272.
21.
de SimoneGDevereuxRBRomanMJ. Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension. J Am Coll Cardiol. 1994;23(6):1444–1451.
22.
GaaschWHZileMRHoshinoPK. Stress-shortening relations and myocardial blood flow in compensated and failing canine hearts with pressure-overload hypertrophy. Circulation. 1989;79(4):872–883.
23.
de SimoneGKimballTRRomanMJ. Relation of left ventricular chamber and midwall function to age in normal children, adolescents and adults. Ital Heart J. 2000;1(4):295–300.
24.
de SimoneGDevereuxRBKorenMJMensahGACasalePNLaraghJH. Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension. Circulation. 1996;93(2):259–265.
25.
NaguehSFAppletonCPGillebertTC. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. Eur J Echocardiogr. 2009;10(2):165–193.
26.
BoudoulasKDSparksEARittgersSE. Factors determining left atrial kinetic energy in patients with chronic mitral valve disease. Herz. 2003;28(5):437–444.
27.
TriposkiadisFHarbasCKelepeshisG. Left atrial remodeling in patients younger than 70 years with diastolic and systolic heart failure. J Am Soc Echocardiogr. 2007;20(2):177–185.
28.
ApostolakisSKonstantinidesS. The right ventricle in health and disease: insights into physiology, pathophysiology and diagnostic management. Cardiology. 2012;121(4):263–273.
29.
CrowleyJPShethSCaponeRJSchillingRF. A paucity of thalassemia trait in Italian men with myocardial infarction. Acta Haematol. 1987;78(4):249–251.
30.
GalleraniMScapoliCCicognaniI. Thalassaemia trait and myocardial infarction: low infarction incidence in male subjects confirmed. J Intern Med. 1991;230(2):109–111.
31.
KarimiMMarvastiVEMotazedianSSharifianM. Is beta-thalassemia trait a protective factor against hypertension in young adults?Ann Hematol. 2006;85(1):29–31.
32.
GoldfarbAWRachmilewitzEAEisenbergS. Abnormal low and high density lipoproteins in homozygous beta-thalassaemia. Br J Haematol. 1991;79(3):481–486.
33.
MaioliMVignaGBTonoloG. Plasma lipoprotein composition, apolipoprotein(a) concentration and isoforms in beta-thalassemia. Atherosclerosis. 1997;131(1):127–133.
34.
FeingoldKRMarshallMGulliRMoserAHGrunfeldC. Effect of endotoxin and cytokines on lipoprotein lipase activity in mice. Arterioscler Thromb. 1994;14(11):1866–1872.
35.
McGillHCJrMcMahanCAMalcomGTOalmannMCStrongJP.Effects of serum lipoproteins and smoking on atherosclerosis in young men and women. The PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 1997;17(1):95–106.
36.
SafarMEBlacherJJankowskiP. Arterial stiffness, pulse pressure, and cardiovascular disease—is it possible to break the vicious circle?Atherosclerosis. 2011;218(2):263–271.
37.
GuardamagnaOAbelloFSaraccoPBaraccoVRolfoEPirroM. Endothelial activation, inflammation and premature atherosclerosis in children with familial dyslipidemia. Atherosclerosis. 2009;207(2):471–475.
38.
AnderssonJSundstromJGustavssonT. Echogenecity of the carotid intima-media complex is related to cardiovascular risk factors, dyslipidemia, oxidative stress and inflammation: the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) study. Atherosclerosis. 2009;204(2):612–618.
39.
WilkinsonIBPrasadKHallIR. Increased central pulse pressure and augmentation index in subjects with hypercholesterolemia. J Am Coll Cardiol. 2002;39(6):1005–1011.
40.
PlanaNFerreRMerinoJ. Heterozygous familial hypercholesterolaemic patients have increased arterial stiffness, as determined using the augmentation index. J Atheroscler Thromb. 2011;18(12):1110–1116.
LantelmePLaurentSBesnardC. Arterial stiffness is associated with left atrial size in hypertensive patients. Arch Cardiovasc Dis. 2008;101(1):35–40.
43.
van SchinkelLDAugerDvan ElderenSG. Aortic stiffness is related to left ventricular diastolic function in patients with diabetes mellitus type 1: assessment with MRI and speckle tracking strain analysis. Int J Cardiovasc Imaging. 2013;29(3):633–641.
44.
Casaclang-VerzosaGGershBJTsangTS. Structural and functional remodeling of the left atrium: clinical and therapeutic implications for atrial fibrillation. J Am Coll Cardiol. 2008;51(1):1–11.
45.
TriposkiadisFTentolourisKAndroulakisA. Left atrial mechanical function in the healthy elderly: new insights from a combined assessment of changes in atrial volume and transmitral flow velocity. J Am Soc Echocardiogr. 1995;8(6):801–809.
46.
JeongSKChoYIDueyMRosensonRS. Cardiovascular risks of anemia correction with erythrocyte stimulating agents: should blood viscosity be monitored for risk assessment?Cardiovasc Drugs Ther. 2010;24(2):151–160.
47.
LaurentSCockcroftJVan BortelL. European Network for Non-Invasive Investigation of Large Arteries. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006;27(21):2588–2605.
48.
SalviPParatiG. Augmentation index as a specific marker of large arteries distensibility: the end of a beautiful tale?J Hypertens. 2012;30(12):2276–2278.
49.
GoslingRGBudgeMM. Terminology for describing the elastic behavior of arteries. Hypertension. 2003;41(6):1180–1182.
50.
CrowleyJPMetzgerJBMerrillEWValeriCR. Whole blood viscosity in beta thalassemia minor. Ann Clin Lab Sci. 1992;22(4):229–235.
51.
McEnieryCMYasminHallIR; ACCT Investigators. Normal vascular aging: differential effects on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT). J Am Coll Cardiol. 2005;46(9):1753–1760.
