Examination of echocardiographic parameters for the early diagnosis of cardiac dysfunction in beta thalassemia major patients
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Abstract
Objective: This study aimed to determine the utility of tissue Doppler, pulse-wave Doppler, and conventional echocardiography for the detection of cardiac dysfunction in the early period in beta thalassemia patients.
Methods: Forty beta thalassemia major patients undergoing regular blood transfusion and chelation therapy and 30 healthy controls with similar demographic factors were included in the study. Both the patient and control groups were examined with, tissue Doppler, pulse-wave Doppler, motion-mode echocardiography. Ferritin values and T2* magnetic resonance measurements were recorded for those in the patient group.
Results: Diastolic dysfunction indicators like early ventricular filling rate, atrial contraction rate, mitral A wave time, and reverse pulmonary venous flow velocity were higher in the patient group (p<0.001, p=0.003, p<0.001, p=0.006, respectively), the deceleration time and pulmonary venous systolic flow velocity (p=0.035, p=0.033, respectively) were lower. Moreover, in thalassemia major patients, there were significant increases in the ratios of early ventricular filling rate to early diastolic myocardial rate in the lateral, basal and mid septal walls (p<0.001, p=0.001, p=0.012, respectively). While the difference between the ferritin values and echocardiographic data was not significant in patient, it was significant between patients with severe and no cardiac iron load regarding an increase in left ventricular end-diastolic thickness and a decrease in left ventricular ejection fraction values (p=0.045, p=0.049, respectively).
Conclusions: In beta-thalassemia major patients, tissue Doppler, pulse-wave Doppler and conventional echocardiography can be used to detect cardiac dysfunction in the early periods in cases where T2* magnetic resonance is not available.
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Lanzkowsky P, Atlas M. Hemolytic Anemia; Thalassemias. Manual of Pediatric Hematology and Oncology 4th ed. New York. 2005;181-191.
Olivieri NF. The beta-thalassemias. The New England journal of medicine. 1999;341(2):99-109.
Kyriacou K, Michaelides Y, Senkus R, Simamonian K, Pavlides N, Antoniades L, et al. Ultrastructural pathology of the heart in patients with beta-thalassaemia major. Ultrastructural pathology. 2000;24(2):75-81.
Modell B, Khan M, Darlison M. Survival in beta-thalassaemia major in the UK: data from the UK Thalassaemia Register. Lancet. 2000;355(9220):2051-2.
Kolnagou A, Economides C, Eracleous E, Kontoghiorghes GJ. Low serum ferritin levels are misleading for detecting cardiac iron overload and increase the risk of cardiomyopathy in thalassemia patients. The importance of cardiac iron overload monitoring using magnetic resonance imaging T2 and T2*. Hemoglobin. 2006;30(2):219-27.
Isaaz K, Thompson A, Ethevenot G, Cloez JL, Brembilla B, Pernot C. Doppler echocardiographic measurement of low velocity motion of the left ventricular posterior wall. The American journal of cardiology. 1989;64(1):66-75.
Silvilairat S, Sittiwangkul R, Pongprot Y, Charoenkwan P, Phornphutkul C. Tissue Doppler echocardiography reliably reflects severity of iron overload in pediatric patients with beta thalassemia. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology. 2008;9(3):368-72.
Pennell DJ. T2* magnetic resonance and myocardial iron in thalassemia. Annals of the New York Academy of Sciences. 2005;1054:373-8.
Wood JC, Noetzli L. Cardiovascular MRI in thalassemia major. Annals of the New York Academy of Sciences. 2010;1202:173-9.
Quinones MA, Otto CM, Stoddard M, Waggoner A, Zoghbi WA, Doppler Quantification Task Force of the N, et al. Recommendations for quantification of Doppler echocardiography: a report from the Doppler Quantification Task Force of the Nomenclature and Standards Committee of the American Society of Echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2002;15(2):167-84.
Hirota Y. A clinical study of left ventricular relaxation. Circulation. 1980;62(4):756-63.
Spirito P, Lupi G, Melevendi C, Vecchio C. Restrictive diastolic abnormalities identified by Doppler echocardiography in patients with thalassemia major. Circulation. 1990;82(1):88-94.
Parale GP, Pawar SS, Tapare VS. Assessment of LV diastolic function in patients with beta-thalassemia major with special reference to E/Eann ratio. Journal of pediatric hematology/oncology. 2009;31(1):69-73.
Ho CY. Echocardiographic Assessment of Diastolic Function. In: Solomon SD editor. Essential Echocardiography: A Practical Handbook with DVD. New Jersey: Humana Press Inc. 2007:119-131.
Kremastinos DT, Tsiapras DP, Tsetsos GA, Rentoukas EI, Vretou HP, Toutouzas PK. Left ventricular diastolic Doppler characteristics in beta-thalassemia major. Circulation. 1993;88(3):1127-35.
Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ, et al. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function--a study in normals and dilated cardiomyopathy. Journal of cardiology. 1995;26(6):357-66.
Ucar T, Ileri T, Atalay S, Uysal Z, Tutar E, Ertem M. Early detection of myocardial dysfunction in children with beta-thalassaemia major. The international journal of cardiovascular imaging. 2009;25(4):379-86.
Feigenbaum H. Role of M-mode technique in today's echocardiography. Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography. 2010;23(3):240-57; 335-7.
Stakos DA, Margaritis D, Tziakas DN, Kotsianidis I, Chalikias GK, Tsatalas K, et al. Cardiovascular involvement in patients with beta-thalassemia major without cardiac iron overload. International journal of cardiology. 2009;134(2):207-11.
Tokgöz H, Çalışkan Ü. Talasemi demir regülasyonu, metabolizması ve demir yükünün tayini. Türkiye Klinikleri J Hem Onc-Special Topics. 2010;3:70-75.
Ashena Z, Ghafurian S, Ehsani MA. The relation between left ventricular diastolic indices and serum ferritin in thalassemia major. Pediatric hematology and oncology. 2007;24(1):3-14.
Fischer R, Harmatz PR. Non-invasive assessment of tissue iron overload. Hematology / the Education Program of the American Society of Hematology American Society of Hematology Education Program. 2009:215-21.
Kirk P, Roughton M, Porter JB, Walker JM, Tanner MA, Patel J, et al. Cardiac T2* magnetic resonance for prediction of cardiac complications in thalassemia major. Circulation. 2009;120(20):1961-8.
Aypar E, Alehan D, Hazirolan T, Gumruk F. The efficacy of tissue Doppler imaging in predicting myocardial iron load in patients with beta-thalassemia major: correlation with T2* cardiovascular magnetic resonance. The international journal of cardiovascular imaging. 2010;26(4):413-21.
Vogel M, Anderson LJ, Holden S, Deanfield JE, Pennell DJ, Walker JM. Tissue Doppler echocardiography in patients with thalassaemia detects early myocardial dysfunction related to myocardial iron overload. European heart journal. 2003;24(1):113-9.