الفهرس 
?- thalassemia MajorOnly 14 pages are availabe for public view
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Abstract
The aim of this study was to assess the levels of serum parathormone and to investigate whether these parameters predispose to cardiac systolic and diastolic dysfunction in patients with B-thalassemia major.
METHODS: Seventy patients with B-thalassemia major with a mean age 14.2 2.9 years.(range :6-18 years),as well as thirty age and sex matched controls, underwent full history taking, clinical examination and laboratory tests including complete blood count ,calcium ,phosphorus, alkaline phosphatase, and intact parathormone levels.Serum ferritin concentrations were derived from each patient’s file ,and mean values were calculated for 1 year prior to the study.
Complete M-mode and pulsed Doppler echocardiography were performed for cases and control to study diastolic and systolic functions and measurements were obtained. Myocardial Performance Index (MPI) was calculated for both the left and right ventricles ,and data was interpreted.
Myocardial iron content and liver iron content were derived from each patient’s file.Myocardial iron content was assessed with magnetic resonance imaging.Each scan included the measurement of both myocardial and hepatic iron by means of T2* based on a method that has been previously described and validated.(Anderson LJ et al 2001)
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RESULTS: The study population was mild to severely iron overloaded. Mean calcium values were significantly lower among the cases, the phosphorus and alkaline phosphatase were significantly higher among the cases compared to the control. The results of parathormone revealed 72.5% normal, 18.5% were hypoparathyroid, 9% patients were hyperparathyroid. There was no statistically significant difference in fractional shortening (FS%) and left ventricular ejection fraction (LVEF %) between the cases and control group. However, the left ventricular diastolic E and E/A indices were significantly higher amongst the cases , indicating restrictive pattern of iron cardiomyopathy. In our study, mean MPI of the left ventricle among our patients was not significantly different than that of the control group. In addition, we observed weak proportionate correlation between PTH level and LIC. There was a weak correlation between PTH level and LVEF. No correlation was found between PTH and serum ferritin, cardiac T2*, Calcium, Phosphorus or Alkaline Phosphatase or other echocardiographic parameters.There was no statistical difference between patients with normal parathyroid levels,hypo- and hyperparathyroid levels regarding laboratory data or echocardiographic functions. Our study cases with increased cardiac iron (T2*<20 ms) were older, had more frequent transfusions, higher LIC, higher ferritin, lower PTH level and lower calcium but all did not reach level of significance . Our results did not demonstrate increased level of PTH in patients having increased myocardial iron deposition
CONCLUSION:Our study showed a high prevalence of hypoparathyroidism, hyperparathyroidism and subclinical cardiac dysfunction among patients with TM with no association between increased myocardial iron accumulation and higher levels of PTH.
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KEY WORDS: Thalassemia major,Parathormone,Systolic and diastolic cardiac functions