Comparison of Tissue Doppler Imaging with MRI T2* and 24-Hour Rhythm Holter Heart Rate Variability for Diagnosing Early Cardiac Impairment in Thalassemia Major Patients

Background- Regular blood transfusions used for long term survival in ß-thalassemia major patients cause a secondary state of tissue iron overload. Myocardial iron deposition can result in cardiomyopathy, and heart failure remains the leading cause of death. This study was planned to see the Right Ventricle (RV) and Left Ventricle(LV)dysfunction in beta thalassemia transfused patients. Method- Patients of ß thalassemia major above 2 years of age received regular blood transfusions at least for 1 year duration, attending OPD in the Department of Pediatrics, S P Medical College, Bikaner were included.Echo was correlated with serum ferritin Level(SFL). Results- Tissue Doppler imaging(TDI) parameters of 50 patients at mitral annulus e.g. Em septal, Em Lateral, Am septal, Am lateral, Sm Septal and Sm Lateral were abnormal(<2SD and >2SD)in 70% & 0%, 50% & 4%, 10% & 46%, 34% & 24%, 40% & 22% and 60% & 10% patients respectively.TDI parameters at tricuspid valvee.g. Et, At and St were abnormal(<2SD)in 98%, 96% and 98% patients respectively. The differences in mean values of Et, At and St, when compared in the SFL groups <2500,2500-5000 and>5000, was non significant(p>0.05). Conclusion- TDI is superior to conventional echocardiography in giving an early evidence of diastolic myocardial dysfunction in asymtopmatic and normal LV function patients.TDI can be applied as an integrated part of assessment of children & adolescents with ß-thalassemia. Septal Sm, Em & lateral Em, Sm, Am and RV Et, At, St were reduced early in majority of patients. Our study showed early involvement of septum and RV in thalassemic patients. Key Words: ß-thalassemia major ;Right Ventricle (RV) and Left Ventricle ( LV) dysfunction; Echocardiogram ;Tissue Doppler Imaging

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EXERCISE STRESS ECHOCARDIOGRAPHY WITH TISSUE DOPPLER IMAGING (TDI) DETECTS EARLY SYSTOLIC DYSFUNCTION IN BETA-THALASSEMIA MAJOR PATIENTS WITHOUT CARDIAC IRON OVERLOAD

Mediterranean Journal of Hematology and Infectious Diseases ◽

10.4084/mjhid.2012.037 ◽

2012 ◽

Vol 4 (1) ◽

pp. e2012037 ◽

Cited By ~ 7

Author(s):

Umberto Barbero

Keyword(s):

Iron Overload ◽

Tissue Doppler Imaging ◽

Myocardial Dysfunction ◽

Thalassemia Major ◽

Tissue Doppler ◽

Exercise Stress ◽

Doppler Imaging ◽

Cardiac Iron ◽

Cardiac Iron Overload ◽

Conventional Echocardiography

Iron Overload Cardiomyopathy (IOC) is still the main cause of death in thalassemia major (TM) patients. Unfortunately, Conventional Echocardiography fails to predict early cardiac dysfunction. As Tissue Doppler Imaging (TDI) may demonstrate regional myocardial dysfunction, we wondered if exercise may reveal abnormalities at TDI which are not evident at rest. To try to evaluate left and right myocardial performances at rest and after maximal exercise by both conventional and TDI parameters, 46 beta-TM adult patients and 39 control subjects were enrolled. All patients had a liver iron quantification by Superconducting Quantum Interference Device (SQUID) and also a cardiac iron assessment by MRI (T2*): 38 TM patients had no evidence of cardiac iron overload. Whereas TM patients did not shown diastolic dysfunction and all of them presented a good global response to exercise, TDI detected a reduced increase of the S’ waves of left ventricle basal segment during exercise. This finding seems to have some weak but interesting relations with iron overload markers. In conclusion, in our study, exercise stress TDI-echocardiography was able to demonstrate subtle systolic abnormalities that were missed by Conventional Echocardiography. Further studies are required to determine the meaning and the clinical impact of these results.

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