Abstract
Background Beta-thalassemia major is a genetic blood disease complicated by splenomegaly, and splenectomy is a standard therapy for this medical condition. Although splenectomy results not only in the improvement of the hematological status, the long-term consequences to the cardiovascular system are still questionable. Objective The aim of the study was to assess and compare the cardiovascular impact of splenomegaly and splenectomy in patients with beta-thalassemia major. Methodology This is a cross-sectional survey conducted at Hayatabad Medical Complex, Peshawar, from January 2024 to June 2024. A total of 88 beta-thalassemia major patients were divided into two groups: 44 patients with splenomegaly were recruited and compared with 44 post-splenectomy patients. Outcomes that were assessed in this study from the medical records were cardiac function test, ejection fraction, left ventricular hypertrophy, thromboembolic incidences, pulmonary embolism, deep vein thrombosis, blood pressure level, and the biochemical markers, B-type natriuretic peptide (BNP) and troponin. The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 26 (IBM Corp., Armonk, USA). Results Patients with splenectomy exhibited slightly lower hemoglobin levels and higher transfusion requirements but had better ejection fractions compared to those with splenomegaly. In contrast, the splenomegaly group demonstrated worse cardiovascular outcomes, including higher rates of left ventricular hypertrophy, pulmonary hypertension, arrhythmias, thromboembolic events, and elevated BNP levels, indicating increased cardiovascular morbidity and hemodynamic strain. Logistic regression analysis further suggested that splenectomy reduces the risk of cardiomyopathy, particularly in younger patients, while the splenomegaly group experiences a greater burden of acute cardiovascular complications. Conclusion Splenectomy in beta-thalassemia major patients offers improved cardiac function and hemoglobin levels while reducing transfusion needs, but it does not eliminate the risks of long-term cardiovascular and thromboembolic complications, such as deep vein thrombosis and pulmonary embolism. On the other hand, patients with splenomegaly face more severe and immediate cardiovascular risks, including hypertension, arrhythmias, and thromboembolic events. These findings underscore the importance of tailored management strategies to optimize outcomes for both groups.