C  2008, the Authors Journal compilation C  2008, Blackwell Publishing, Inc. DOI: 10.1111/j.1540-8175.2008.00641.x Prognostic Value of Doppler-Demonstrated Left versus Biventricular Restrictive Filling Pattern in Thalassemia Major To the Editor: We read with great interest the article by Hamdy et al. 1 on the right ventricular (RV) function in patients with thalassemia major (TM). The authors reported that these patients present RV diastolic dysfunction, while RV sys- tolic dysfunction is correlated to the serum lev- els of ferritin. However, they did not evaluate the impact of the cardiac dysfunction on the sur- vival of TM patients. Cardiac function in TM patients remains nor- mal for many years, but once symptoms of heart failure become evident, death usually occurs within 1 year. 2 Iron overload of the heart is the main cause of cardiac dysfunction and death in these patients. 3 Thus, the main concern is to de- tect early markers of cardiac function with prog- nostic impact on survival. In a previous work we have found that left ventricular (LV) restric- tive filling pattern (RFP) is an important pre- dictor of cardiac mortality in 45 asymptomatic transfusion-dependent patients with TM. 4 The 15-year cumulative survival rate was 58% in patients with LV RFP and 88% in patients with LV non-RFP (log-rank statistic = 6.02, P = 0.014). In order to investigate the prognostic signifi- cance of LV or biventricular RFP, our cohort of 45 TM patients with normal LV systolic func- tion by Doppler echocardiography was catego- rized into three groups: Patients with both LV and RV RFP at baseline (Group 1, n = 6), pa- tients with only LV RFP (Group 2, n = 14), and patients with normal filling patterns of both ventricles (Group 3, n = 25). Of note, none of the Address for correspondence and reprint requests: Georgios Efthimiadis, M.D., First Cardiology Department, Aristotle University of Thessaloniki, AHEPA Hospital, Stilp. Kiriakidi 1, GR-54637, Thessaloniki, Greece, Fax: +30231099395; E-mail: efthymos@med.auth.gr patients had only RV RFP at baseline. During follow-up, 11 of 45 patients (24.4%) died from cardiac causes. Four of them belonged in Group 1, 4 in Group 2 and 3 patients were in Group 3. The 15-year cumulative survival rate was 33% in Group 1 patients, 71% in Group 2, and 88% in Group 3 (log-rank statistic = 11.62, P = 0.003). Mean survival in Group 1 was 7.9 ± 2.1 years (95% CI 3.6 to 12.1 years), compared with 12.7 ± 1.2 years (95% CI 10.4 to 14.9 years) in Group 2, and 14.2 ± 0.5 years (95% CI 13.2 to 15.1 years) in Group 3. We conclude that biventricular RFP is an ominous sign in asymptomatic transfusion de- pendent patients with TM with a worse prog- nostic significance than LV RFP alone. Georgios K. Efthimiadis ∗ Georgios Giannakoulas ∗ Helen P. Hassapopoulou † Haralambos I. Karvounis ∗ Georgios E. Parcharidis ∗ ∗ Cardiology Department, AHEPA Hospital Aristotle University of Thessaloniki, Greece † Thalassemia Unit, AHEPA Hospital Thessaloniki, Greece References 1. Hamdy AM, Zein El-Abdin MY, et al: Right ventricu- lar function in patients with beta thalassemia: relation to serum ferritin level. Echocardiography 2007;24:795– 801. 2. Engle MA, Erlandson M, Smith CH: Late cardiac com- plications of chronic, severe, refractory anemia with hemochromatosis. Circulation 1964;30:698–705. 3. Olivieri NF, Nathan DG, MacMillan JH, et al: Survival in medically treated patients with homozygous beta- thalassemia. N Engl J Med 1994;331:574–578. 4. Efthimiadis GK, Hassapopoulou HP, Tsikaderis DD, et al: Survival in thalassaemia major patients. Circ J 2006;70:1037–1042. Vol. 25, No. 5, 2008 ECHOCARDIOGRAPHY: A Jrnl. of CV Ultrasound & Allied Tech. 553