Improved Endothelial Function with Combined Chelation Therapy in Thalassaemia Major.

Background: In β-thalassemia major (TM) myocardial iron toxicity is the dominant cause of ventricular dysfunction, with heart failure responsible for the majority of deaths. Abnormal endothelial function has also been described in these patients and could further contribute to cardiovascular complications. Endothelial function can be determined by measurement of flow mediated dilatation of the brachial artery (FMD). This can be assessed reproducibly by cardiovascular magnetic resonance (CMR).

Aims: To report the changes in endothelial function, LV ejection fraction and ferritin from a randomized placebo controlled trial comparing combined chelation therapy (deferiprone and deferoxamine) with deferoxamine monotherapy.

Methods: 65 patients (male 27, female 38, age 28.7+/−4.8years) with mild-moderate myocardial iron loading (heart T2* 8–20ms) were randomized to receive either deferoxamine with placebo (placebo group), or deferoxamine with deferiprone (combined group). FMD was assessed at baseline and after 12 months.

Results: There were significant improvements in endothelial function in the combined treatment group compared with the placebo group (+8.8% vs 3.1% p=0.013). This was in accord with improvements in the combined group in left ventricular ejection fraction (+2.4% vs +0.6%, p=0.02), and serum ferritin (−870 vs −194 μg/L; p<0.001). These findings were in accord with improved myocardial T2* in the combined group (+43% vs +23%, p=0.017),

Conclusion: In patients with mild-moderate cardiac iron loading, the combined therapy of deferiprone and deferoxamine is superior to deferoxamine alone in improving endothelial function, cardiac function and ferritin, as well as reducing myocardial iron.