# B‐Type Natriuretic Peptides Levels in Patients With Beta‐Thalassemia Major and Correlations With Biomarkers: A Systematic Review and Meta‐Analysis

## TL;DR

This study finds that patients with beta-thalassemia major have elevated B-type natriuretic peptides, indicating a higher risk of heart problems.

## Contribution

The study provides a meta-analysis of BNP and NT-proBNP levels in beta-thalassemia major and their correlations with biomarkers.

## Key findings

- NT-proBNP and BNP levels are significantly higher in beta-thalassemia major patients compared to healthy controls.
- NT-proBNP is significantly correlated with serum ferritin, E/E′ ratio, and patient age.
- Elevated B-type natriuretic peptides suggest early myocardial stress and subclinical heart disease in these patients.

## Abstract

Patients with beta‐thalassemia major are prone for developing cardiovascular complications. Early identification of patients at risk is important. B‐type natriuretic peptides such as brain natriuretic peptide (BNP) and N‐terminal pro‐BNP (NT‐proBNP) are sensitive indicators of cardiac dysfunction. This review synthesizes the existing evidence on the levels of B‐type natriuretic peptides in beta‐thalassemia major and their relationship with markers of cardiac dysfunction and other biomarkers.

A systematic review was conducted according to PRISMA guidelines. The search was performed in the PubMed, Web of Science, ScienceDirect, and World Health Organization Virtual Health Library Regional Portal. Pooled standardized mean differences (SMD) and correlation coefficients (r) with 95% confidence intervals (CI) were calculated to investigate the differences in B‐type natriuretic peptides values and their relationships with various biomarkers in beta‐thalassemia major.

A total of 29 studies were selected for the systematic review. Of them, 27 were included in the meta‐analyses. Most of the included studies focused on investigating NT‐proBNP. The analyses revealed significantly higher NT‐proBNP and BNP values in patients with beta‐thalassemia major compared to healthy controls. For NT‐proBNP, the pooled effect size (SMD) was 1.37 (95% CI: 0.856–1.893, p < 0.001), and for BNP, it was 1.94 (95% CI: 0.665–3.220, p = 0.003). Meta‐analyses of correlations revealed that NT‐proBNP was significantly correlated with serum ferritin levels (r = 0.471, p = 0.006), E/E′ ratio (r = 0.528, p < 0.001), and patients age (r = 0.259, p = 0.004).

This systematic review provides evidence that beta‐thalassemia is associated with high levels of B‐type natriuretic peptides, which highlight the high risk of cardiovascular complications in this patient population. The significantly elevated levels of both molecules and their identified correlations emphasize clinical utility of them as markers of early myocardial stress and subclinical heart disease in beta‐thalassemia.