Cardiac complications and iron overload in beta thalassemia major patients—a systematic review and meta-analysis

  • F. Koohi
  • T. Kazemi
  • E. Miri-MoghaddamEmail author
Review Article


Despite the major improvement in therapeutic management of thalassemia major, iron overload is considered a challenging conundrum in these patients and heart disease still remains a major cause of morbidity and mortality in these patients. Therefore, this study aimed to investigate the prevalence of cardiac iron overload and cardiovascular complications in transfusion-dependent thalassemia patients in the worldwide. The following databases were searched: ISI/Web of Science, Embase, PubMed, Scopus, up to February 30, 2018. The quality of the studies was evaluated using the Joanna Briggs Institute Prevalence Critical Appraisal Tool. The random model based on Metaprop was used. One hundred forty-two studies were included. The total number of patients included was 26,893. The mean age of patients was 22.6 (SD = 1.7) years. Based on Metaprop, the overall prevalence of cardiac iron overload/myocardial sidoresis (T2* < 20 ms) and cardiac complications in thalassemia major patients in the worldwide was 25% (95% CI 22–28%) and 42% (95% CI 37–46%), respectively. The results of this study show that the prevalence of cardiac iron overload and cardiovascular complications in patients with thalassemia major is almost high. Therefore, iron chelation and careful monitoring of serum ferritin level will prevent the cardiac iron overload, and interval monitoring of patients with transfusion-dependent thalassemia (TDT) by echocardiography and electrocardiography will help with early detection of cardiovascular complications.


Cardiac iron overload Myocardial sidoresis Cardiac complications Major thalassemia 



β-Thalassemia major


Transfusion-dependent thalassemia


Cardiac iron overload


Pulmonary hypertension


Tricuspid regurgitation


Magnetic resonance


Authors’ contribution

F. Koohi was the main investigator and drafted the manuscript. E. Miri-Moghaddam and T. Kazemi were the study supervisors and contributed to all aspects of the study.

Funding information

This study is financially supported by the Research Deputy of Birjand University of Medical Sciences.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Student Research Committee, Department of Epidemiology, School of Public Health and SafetyShahid Beheshti University of Medical SciencesTehranIran
  2. 2.Cardiovascular Diseases Research Center & Department of Cardiology, Faculty of MedicineBirjand University of Medical SciencesBirjandIran
  3. 3.Cardiovascular Diseases Research Center & Dep. of Molecular Medicine, Faculty of MedicineBirjand University of Medical SciencesBirjandIran

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