Early detection of cardiac dysfunction in thalassemic patients by radionuclide angiography and heart rate variability analysis

Chiara, Benedetta De; Crivellaro, Wilma; Sara, Roberto; Ruffini, Livia; Parolini, Marina; Fesslová, Vlasta; Carnelli, V.; Fiorentini, Cesare; Parodi, Oberdan

doi:10.1111/j.1600-0609.2005.00434.x

Cited by 28 publications

(31 citation statements)

References 24 publications

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“…In the early stage, patients are usually asymptomatic. Restrictive cardiomyopathy usually occurs before dilated cardiomyopathy (7), in accordance with diastolic dysfunction, which normally happens before systolic dysfunction and overt heart failure (8)(9)(10)(11)(12).…”

Section: Clinical Insightmentioning

confidence: 99%

“…Left-sided heart failure is clinically more common than right-sided heart failure (12). However, it has been shown that right ventricular dysfunction develops earlier in asymptomatic TM patients (9,17).…”

Section: Clinical Insightmentioning

confidence: 99%

“…Because chelation therapy is an effective way of preventing iron overload cardiomyopathy, the methods and/or markers that can accurately assess cardiac iron status and predict the development of cardiac complications are essential (8,9,11,12,15,16,(22)(23)(24)(25)(26). Many methods and parameters, both direct and indirect, have been investigated.…”

Section: Assessment and Markers Of Cardiac Iron Statusmentioning

confidence: 99%

“…While conventional standard echocardiographic measurements usually demonstrate positive findings at the late stage (38), low-dose dobutamine stress echocardiography may be useful for early detection of cardiac dysfunction in patients at risk for cardiac hemosiderosis (11). Recently, tissue Doppler echocardiography (8) and radionuclide angiography (with exercise or low-dose dobutamine stimulation) (9) have been shown to detect regional wall motion abnormality, even in early-stage thalassemic patients. This finding may also reflect patchy, nonhomogeneous deposition of iron in cardiac muscle.…”

Section: Assessment For the Development Of Iron Overload Cardiomyopathymentioning

confidence: 99%

“…In this study, TM patients with VLP showed a higher incidence of premature ventricular contraction, with episodes of nonsustained ventricular tachycardia. Recently, De Chiara et al (9) reported that decreased HRV parameters can be detected as early as ventricular regional wall motion in asymptomatic TM patients (n=20). However, no longterm follow-up study has been reported to confirm the validity of HRV parameters for predicting cardiac dysfunction and mortality in iron overload thalassemic patients.…”

Section: Assessment For the Development Of Iron Overload Cardiomyopathymentioning

confidence: 99%

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Iron overload thalassemic cardiomyopathy: Iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity

Lekawanvijit

Chattipakorn

2009

Canadian Journal of Cardiology

101

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Section: Clinical Insightmentioning

confidence: 99%

Section: Clinical Insightmentioning

confidence: 99%

Section: Assessment and Markers Of Cardiac Iron Statusmentioning

confidence: 99%

Section: Assessment For the Development Of Iron Overload Cardiomyopathymentioning

confidence: 99%

Section: Assessment For the Development Of Iron Overload Cardiomyopathymentioning

confidence: 99%

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Iron overload thalassemic cardiomyopathy: Iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity

Lekawanvijit

Chattipakorn

2009

Canadian Journal of Cardiology

101

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Electrocardiographic consequences of cardiac iron overload in thalassemia major

et al. 2011

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Background Iron cardiomyopathy is a leading cause of death in transfusion dependent thalassemia major (TM) patients and MRI (T2*) can recognize preclinical cardiac iron overload, but, is unavailable to many centers. Design and Methods We evaluated the ability of 12-lead electrocardiography to predict cardiac iron loading in TM. 12-lead electrocardiogram and cardiac T2* measurements were performed prospectively, with a detectable cardiac iron cutoff of T2*less than 20 ms. Patients with and without cardiac iron were compared using two-sample statistics and against population norms using age and gender-matched Z-scores. Results 45/78 patients had detectable cardiac iron. Patients having cardiac iron were older and more likely female but had comparable liver iron burdens and serum ferritin. Increased heart rate (HR) and prolonged corrected QT interval (QTc) were present, regardless of cardiac iron status. Repolarization abnormalities were the strongest predictors of cardiac iron, including QT/QTc prolongation, left shift of T-wave axis, and interpretation of ST/T-wave morphology. Recursive partitioning of the data for females using T-axis and HR and for males using QT, HR and T-axis produced algorithms with AUROC’s of 88.3 and 87.1 respectively. Conclusions Bradycardia and repolarization abnormalities on 12-lead electrocardiography were the most specific markers for cardiac iron in thalassemia major. Changes in these variables may be helpful to stratify cardiac risk when cardiac MRI is unavailable. However, diagnostic algorithms need to be vetted on larger and more diverse patient populations and longitudinal studies are necessary to determine reversibility of the observed abnormalities.

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Heart Rate Variability in Patients with Thalassemia Major

et al. 2008

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Cardiac dysfunction, including congestive heart failure and fatal arrhythmia, is a frequent cause of death among children with thalassemia major (TM). Autonomic nervous system activity typically is measured by a series of cardiovascular autonomic function tests, but these tests are unsuitable for young patients because they are invasive or complex. Heart rate variability assessment is a technique that measures the beat-to-beat variability in R-R intervals. This variability reflects changes in autonomic activity and their impact on cardiovascular function. This study examined 32 patients with TM to evaluate heart rate variability (HRV) in a preclinical phase of cardiac involvement. The study patients showed no evidence of heart failure or signs of peripheral or autonomic neuropathy. All HRV parameters were significantly reduced in the TM patient group compared with the control group. The results of this study can be interpreted as evidence of early cardiac autonomic neuropathy in young thalassemic patients. Therefore, all TM patients should be screened using HRV analysis for that complication.

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Early detection of cardiac dysfunction in thalassemic patients by radionuclide angiography and heart rate variability analysis

Abstract: Right ventricular dysfunction and abnormal HRV may represent the early features of cardiac disease in thalassemic patients with no evidence of ventricular dysfunction at routine evaluation.

Cited by 28 publications

References 24 publications

Iron overload thalassemic cardiomyopathy: Iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity

Iron overload thalassemic cardiomyopathy: Iron status assessment and mechanisms of mechanical and electrical disturbance due to iron toxicity

Electrocardiographic consequences of cardiac iron overload in thalassemia major

Heart Rate Variability in Patients with Thalassemia Major

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