Evaluation of some heart enzymes and Iron levels in β-thalassemia patients in Thi-Qar City, Iraq

Authors

DOI:

https://doi.org/10.21123/bsj.2023.8352

Keywords:

c.TnI, CK-MB, β-thalassemia, Heart disorders, iron overload

Abstract

Beta thalassemia is one of the most common hereditary diseases in the world caused by a deficiency of globin chains. Heart disease is one of the main complications of this disease as a result of excess iron deposition in the cardiac tissues. Total of 100 patients of 2-18 years diagnosed with ß-TM were employed in the current study and admitted to Thi-Qar Center of Hereditary Blood Diseases in Thi-Qar city, Iraq, and 80 healthy participants, matched by age, and geographical area were adopted as control group. The current study included evaluating of serum Troponin I (c.TnI), Creatine kinase-MB isoenzyme (CK-MB), Apelin, aspartate aminotransferase (AST), and Lactate Dehydrogenase enzyme (LDH) of studied groups. The finding revealed a significant increase (p<0.01) of c.TnI, CK-MB, AST, and LDH levels as well as a significant decrease (p<0.01) in apelin level in all patients with ß-TM compared to the control group. Pearson's correlation coefficient (r) was also found between the biochemical parameters studied for ß-TM patients with ferritin level, were found a significant correlation (p<0.01) between ferritin level with CK-MB, LDH, and AST levels while there was no significant correlation (P>0.01) through apelin and c.TnI levels. The finding showed a clinical predictor to damage cardiac tissues in the near term, which portends the use of more efficient treatment protocols to remove excess iron from ß-TM patients.

References

Adnan IA, Meaad KH, Assad FW. β-Thalassemia mutations among thalassemia major patients in Basrah Province – Iraq. Int J Curr Microbiol Appl Sci. 2016;5(5):448–457 https://doi.org/10.20546/ijcmas.2016.505.047.

Richardson R, Issitt R, Crook R. Beta-thalassemia in the paediatric cardiac surgery setting-a case report and literature review. Perfusion. 2018 Apr; 33(3): 232-234‏ https://doi.org/10.1177/0267659117729889 .

Sadeghi MV, Mirghorbani M, Akbari R. β-Thalassemia minor & renal tubular dysfunction: is there any association?. BMC Nephrol. 2021 Dec; 22(1): 1-7 https://doi.org/10.1186/s12882-021-02602-9 .

Raveendran B, Dungarwalla M. Thalassaemia-part 1: a clinical update for the dental team. Br Dent J. 2022 Dec; 233(11): 931-937.‏ https://doi.org/10.1038/s41415-022-5302-7 .

Rashid A, Tabassum S, Naeem A, Naveed A, Iqbal H, Tabassum S, et al. A rare and novel mutation in a beta-globin gene of thalassemia patient of Pakistan: A case report. Ann Med Surg. 2022 Dec; 84: 104918 https://doi.org/10.1016/j.amsu.2022.104918 ‏.

Paul A, Thomson VS, Refaat M, Al-Rawahi B, Taher A, Nadar SK. Cardiac involvement in beta-thalassaemia: current treatment strategies. Postgrad Med. 2019 May; 131(4): 261-267 https://doi.org/10.1080/00325481.2019.1608071.

Abdul-Zahra HA, Hassan MK, Ahmed BA. Health-related quality of life in children and adolescents with β-thalassemia major on different iron chelators in Basra, Iraq. J Pediatr Hematol Oncol. 2016; 38(7):503–511 https://doi.org/10.1097/MPH.0000000000000663.

Sadullah RK, Atroshi SD, Al-Allawi NA. Complications and challenges in the management of Iraqi patients with β-thalassemia major: a single-center experience. Oman Med J. 2020 Jul; 35(4): e152 https://doi.org/10.5001%2Fomj.2020.72 .

Abdulwahid DA, Hassan MK. β- and α-Thalassemia intermedia in Basra, Southern Iraq. Hemoglobin. 2013;37(6):553-563 https://doi.org/10.3109/03630269.2013.825841.

Pepe A, Gamberini MR, Missere M, Pistoia L, Mangione M, Cuccia L, et al. Gender differences in the development of cardiac complications: a multicentre study in a large cohort of thalassaemia major patients to optimize the timing of cardiac follow‐up. Br J Haematol. 2018 Mar; 180(6): 879-888‏ https://doi.org/10.1111/bjh.15125.

Hamza MA, AL-Tamer YY, AL-Habib OAM. Modification of Irisin Level in Overweight/Obese Women during Pregnancy and Its Association with Some Metabolic Risk Factors. Baghdad Sci J. 2020 Sep 8; 17(3 (Suppl.)): 1124-1132 https://doi.org/10.21123/bsj.2020.17.3(Suppl.).1124.

Auda FM, Salman D, Saleh AA. A study effect of Iron overload on Thyroid gland and other tissues in thalassemia patients in najaf city. Al-Kufa U J Bio. 2019; 11(2).‏ https://www.iasj.net/iasj/download/22fcdd6c38d68a8c.

Auda FM, Saleh AA, Ali DS. The frequency of 6 beta-thalassemia mutations in the Iraqi patients from Najaf province. Gene Rep. 2019 Dec; 17: 100516 https://doi.org/10.1016/j.genrep.2019.100516.

Kim H. Diagnosis and treatment of transfusion-related iron overload. J Korean Med Assoc. 2022 Oct; 65(10): 662-672 http://dx.doi.org/10.5124/jkma.2022.65.10.662.

Fibach E, Dana M. Oxidative stress in β-thalassemia. Mol Diagn Ther. 2019 Nov; 23(2): 245-261https://doi.org/10.1007/s40291-018-0373-5 .

Koohi F, Kazemi T, Miri-Moghaddam E. Cardiac complications and iron overload in beta thalassemia major patients—a systematic review and meta-analysis. Ann Hematol. 2019 Feb; 98(6): 1323-1331 https://doi.org/10.1007/s00277-019-03618-w .

Ahmed RA, Salih AF, Omer SH, Rahman HS, Rasool LK. Early Detection of Iron Overload Cardiomyopathy in Transfusion Dependent Thalassemia Patients in Sulaimaniyah City, Iraq. Ther Clin Risk Manag. 2022 Mar; 18: 259-271 https://doi.org/10.2147%2FTCRM.S354574 .

Pepe A, Pistoia L, Gamberini MR, Cuccia L, Lisi R, Cecinati V, et al. National networking in rare diseases and reduction of cardiac burden in thalassemia major. Eur Heart J. 2022 Jul; 43(26): 2482-2492 https://doi.org/10.1093/eurheartj/ehab851 .

Tantawy AAG, Tadros MAR, Adly AAM, Ismail EAR, Ibrahim FA, Eldin NMS, et al. Endothelin-1 gene polymorphism (G8002A) and endothelial monocyte-activating polypeptide II: Role in vascular dysfunction in pediatric patients with β-thalassemia major. Cytokine. 2023 Jun; 161: 156048 https://doi.org/10.1016/j.cyto.2022.156048 .

Al-Hameedawi AKJ, Al-Shawi AA. Identification of novel mutations in β-thalassemia patients in Maysan Governorate, Iraq. Mol Biol Rep. 2023;50(4): 3053-3062 https://doi.org/10.1007/s11033-023-08271-1.

Chaulin AM. Cardiac troponins metabolism: From biochemical mechanisms to clinical practice (literature review). Int J Mol Sci. 2021; 22(20):10928 https://doi.org/10.3390/ijms222010928 .

Deraz SE, Abd El Naby SA, Mahmoud AA. Assessment of ventricular dysfunction in Egyptian children with Beta-thalassemia major. Hematol Oncol Stem Cell Ther. 2021 Sep;14(3): 206-213 https://doi.org/10.1016/j.hemonc.2020.07.003 .

Wang GM, Li Y, Wu S, Zheng W, Ma JJ, Xu F, et al. The combination of creatine kinase-myocardial band isoenzyme and point-of-care cardiac troponin/contemporary cardiac troponin for the early diagnosis of acute myocardial infarction. World J Emerg Med, 2022; 13(3): 163-168 https://doi.org/10.5847%2Fwjem.j.1920-8642.2022.033 .

Ostojic SM, Stea TH, Engeset D. Creatine as a Promising Component of Paternal Preconception Diet. Nutrients. 2022 Jan;14(3):586 https://doi.org/10.3390/nu14030586 .

Hung SY, Hung YM, Fang HC, Yeh JH, Hung GC, Wu CJ, et al. Cardiac troponin I and creatine kinase isoenzyme MB in patients with intradialytic hypotension. Blood purifi. 2004; 22(4): 338-343 https://doi.org/10.1159/000079188 .

Parsanathan R, Jain SK. Novel invasive and noninvasive cardiac-specific biomarkers in obesity and cardiovascular diseases. Metab Syndr Relat Disord. 2020 Jun; 18(1): 10-30 https://doi.org/10.1089/met.2019.0073 .

Zamily OM, Al Mashhedy LAM, Hadwan MH, Muzhir BS, Kadim RT. The Correlation between Lactate Dehydrogenase, Creatine Kinase and Total thiol Levels in Sera of Patients with β Thalassemia. Irq Nat J Chem. 2010; 2010(39): 565-570 https://www.iasj.net/iasj/download/ab72f115c046a08c.

Sakha, K, Samadi M, Rezamand A. Cardiac involvement of major thalassemia and evaluation of total serum creatine kinase and creatine kinase-mB isoenzyme and cardiac troponinI in these patients. Pak J Biol Sci. 2008 Apr; 11(7): 1059-1062‏ https://doi.org/10.3923/pjbs.2008.1059.1062 .

Shahramian I, Razzaghian M, Ramazani AA, Ahmadi GA, Noori NM, Rezaee AR. The correlation between troponin and ferritin serum levels in the patients with major beta-thalassemia. Int Cardiovasc Res J. 2013 Jun; 7(2): 51-55 https://brieflands.com/articles/ircrj-12699.pdf.

Elbarbary NS, Ismail EAR, Roushdy A, Fahmy E. Serum apelin as a novel non-invasive marker for subclinical cardiopulmonary complications in children and adolescents with sickle cell disease. Blood Cells Mol Dis. 2016 Mar; 57: 1-7 https://doi.org/10.1016/j.bcmd.2015.11.001 .

Shwayel AJ, Jewad AM, Abdulsattar MQ. Evaluation of serum cystatin-C and netrin-1 as predictive biomarkers for renal injury in children with beta-thalassemia major. J Appl Hematol. 2023;14(3):236-241‏ https://doi.org/10.4103/joah.joah_29_23.

Vlahos AP, Koutsouka FP, Papamichael ND, Makis A, Baltogiannis GG, Athanasiou E. et al. Determinants of pulmonary hypertension in patients with Beta-thalassemia major and normal ventricular function. Acta Haematol. 2012 Aug ;128(2):124-129 https://doi.org/10.1159/000338825 .

Phrommintikul A, Sukonthasarn A, Kanjanavanit R, Nawarawong W. Splenectomy: a strong risk factor for pulmonary hypertension in patients with thalassaemia. Heart. 2006 Apr; 92(10): 1467-1472 http://dx.doi.org/10.1136/hrt.2005.079970 .

Ndrepepa G. Aspartate aminotransferase and cardiovascular disease—a narrative review. J Lab Precis Med. 2021; 6(6). https://jlpm.amegroups.com/article/view/5898/pdf.

‏ Fianza PI, Rahmawati A, Widihastha SH, Afifah S, Ghozali M, Indrajaya A, et al. Iron overload in transfusion-dependent Indonesian thalassemic patients. Anemia. 2021 Apr;2021 https://doi.org/10.1155/2021/5581831 .

Patel SA, Siddiqui AM, Kareem I. Correlative study of serum bilirubin and liver enzymes with serum ferritin in beta thalassaemia major. IOSR J Dent Med Sci. 2018 Jan; 1: 62-67 https://www.iosrjournals.org/iosr-jdms/papers/Vol17-issue1/Version-2/N1701026267.pdf.

Mohammed SK, Taha MM, Taha EM, Mohammad MNA. Cluster analysis of biochemical markers as predictor of COVID-19 severity. Baghdad Sci J. 2022 Dec 5; 19(6 (Suppl.)): 1423-1429 https://doi.org/10.21123/bsj.2022.7454.

Yamaguchi S, Abe M, Arakaki T, Arasaki O, Shimabukuro M. Prognostic value of lactate dehydrogenase for mid-term mortality in acute decompensated heart failure: a comparison to established biomarkers and brain natriuretic peptide. Heart Lung Circ. 2020 Sep; 29(9): 1318-1327 https://doi.org/10.1016/j.hlc.2019.11.013 .

Kurtoğlu B, ERKILIÇ B, Gürsel DY, Arslan G, BACAKSIZOĞLU O, Altundal P, et al. Myocardial Infarction Diagnosis and Cardiac Troponins. Turk Med Stud J. 2020;7(3):159-70 http://dx.doi.org/10.4274/tmsj.galenos.2020.07.03.07.

Tilea I, Varga A, Serban RC. Past, present, and future of blood biomarkers for the diagnosis of acute myocardial infarction—promises and challenges. Diagnostics. 2021; 11(5): 881 https://www.mdpi.com/2075-4418/11/5/881# .

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Evaluation of some heart enzymes and Iron levels in β-thalassemia patients in Thi-Qar City, Iraq. Baghdad Sci.J [Internet]. [cited 2024 Apr. 30];21(6). Available from: https://bsj.uobaghdad.edu.iq/index.php/BSJ/article/view/8352