Can two‐dimensional speckle tracking echocardiography be useful for left ventricular assessment in the early stages of hereditary haemochromatosis?

Abstract

Background Hereditary haemochromatosis (HH) is a common inherited disease. Abnormally increased intestinal iron absorption and accelerated recycling of iron by macrophages lead to progressive body iron accumulation and the generation of oxidative stress. In the late stages, iron overload can lead to dysfunction of the left ventricle (LV). It is believed that two‐dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately than conventional echocardiography. This accurate evaluation seems to be clinically important in the early stages of HH before substantial damage of the LV. Evaluation of this assessment was the purpose of this paper. Methods We prospectively enrolled 24 patients with early diagnosed HH and without any history of cardiovascular diseases; 23 healthy age‐ and sex‐matched volunteers constituted the control group. Standard echocardiographic parameters and LV rotation and strain parameters were assessed and compared between the groups. Results All echocardiographic parameters were within normal ranges, and there were no differences between the groups. 2D STE revealed significantly worse basal and apical rotation, twist and torsion values in HH patients. The peak systolic longitudinal strain was decreased in HH patients, even though the LV ejection fraction (LVEF) was normal. There were weak correlations between the iron turnover and 2D STE parameters. Conclusions 2D STE seems to be more sensitive than traditional echocardiography for detecting LV abnormalities in HH patients who are diagnosed early. The results of this study may be clinically useful, but their relevance and therapeutic implications remain to be confirmed by further studies.

Diagnosis and management of hereditary haemochromatosis

“…In the early stages of cardiac iron deposition, echocardiographic parameters generally remain in reference range, but certain techniques including two‐dimensional speckle tracking echiocardiography can increase the sensitivity for early left ventricular dysfunction . In more advanced cardiac disease, certain echocardiographic parameters, including radial strain, isovolumic relaxation time and left atrial force, can be deranged but have been shown to significantly improve with a course of therapeutic phlebotomy .…”

Influence of hereditary haemochromatosis on left ventricular wall thickness: does iron overload exacerbate cardiac hypertrophy?

“…This is a diverse group of cardiac diseases characterised by the deposition of abnormal substances within the heart tissue that causes the ventricular walls to develop either diastolic or, less common, systolic dysfunction. Recently the growing interest of scientists in this issue affects hereditary haemochromatosis (HH), which is characterised by the excess deposition of iron mostly due to HFE gene mutation [1,12,14]. Dysfunction of molecules that control iron homeostasis leads to excessive iron absorption in the duodenum and upper section of the small intestine, as well as its maldistribution.…”

The Importance of Multimodality Imaging in the Diagnosis and Management of Patients with Infiltrative Cardiomyopathies: An Update

“…All standard echocardiographic measurements were within normal limits in all study subjects. However, 2D-STE demonstrated remarkably worse basal and apical rotation, twist, and torsion values in the HH subgroup, with decreased peak systolic longitudinal strain [66].…”