The relation of fragmented QRS with tissue Doppler derived parameters in patients with b-thalassaemia major

Abstract

Turkey e relation of fragmented QRS with tissue Doppler derived parameters in patients with b-thalassaemia major AbstractPurpose: e most important complication encountered in patients with b-thalassaemia major is degenerative brosis developing as a result of iron accumulation in myocardial tissue. Dysfunction pursues this accumulation. Recently, presence of fragmented QRS (fQRS) in ECG has been regarded as a predictor of myocardial brosis. We aimed in our study to investigate the frequency with which fQRS develops in patients with bthalassaemia major and to disclose the correlation between fQRS frequency and Dopplerderived indices.Methods: e patients with b-thalassaemia major (n=66; mean age: 23±6 years) and healthy controls (n=30; mean age: 23±4 years) were included. fQRS pattern was described as presence of RSR' manifested as existence of additional R wave and notching in either R or S waves in ECG recordings. 2D, M-mode, conventional Doppler, tissue Doppler echocardiography parameters were assessed. Mean serum ferritin levels over past 5 years were also calculated.Results: When compared to those in control group, fQRS was more frequent in bthalassaemia major group, indicating statistical signi cance (p = 0.001). While E/Em and ferritin level exhibited statistically signi cant increase in thalassaemia patients with fQRS (p < 0.05), the mean Em and Sm values were found to be signi cantly low (p < 0.05).Conclusions: fQRS was frequently observed in the patients with b-thalassaemia major, which was of statistical signi cance. Tissue Doppler-derived diastolic and systolic indices in thalassaemia cases with fQRS showed statistically signi cant impairment compared to those without fQRS. In conclusion, fQRS may represent a novel noninvasive marker for cardiac involvement in patients with b-thalassaemia major. e most important complication in patients with bthalassaemia major is cardiac dysfunction due to accumulation of iron in myocardial cells [1]. Heart failure holds the topmost position among the mortality reasons in patients with bthalassaemia major [2]. 50% of the cases with thalassaemia major are complicated with manifest heart failure, for which reason early diagnosis may prove helpful in the treatment [3,4].Recently, existence of fragmented QRS (fQRS) in ECG strips has been regarded as a predictor of myocardial brosis [5]. at fQRS proved to be a novel marker pointing out possible existence of myocardial scar was documented in the patients with coronary arterial disease [6].Various number of parameters related to conventional Doppler echocardiography was used during investigations on the cardiac functioning in the patients with b-thalassaemia until now [7]. We used in our study the tissue Doppler imaging modality which has less technical limitations compared to conventional Doppler echocardiography.What we aimed in this study was to disclose relationship between tissue Doppler echocardiography-derived indices and frequency of fQRS, a possibly novel indicator that may be used in the early identi cation of cardia...

Assessment of the relationship between fragmented QRS and cardiac iron overload in patients with beta-thalassemia major

“…A study on the early diagnosis of cardiac dysfunction by TDI in asemptomatic TM patients ( 27 ) showed regional systolic dysfunction of the lateral free wall and regional diastolic dysfunction in the septal and right ventricular wall. Another investigation with TDI ( 28 ) reported a significant relationship between the presence of fQRS and impairment of TDI parameters in TM patients.…”

Cardiac Hemosiderosis in Transfusion DependentThalassemia: A Mini-Review

“…However, a specific ECG feature known as Fragmented QRS characterized with additional R waves along with abnormal wave morphology may be an early sign of cardiac iron overload in ECG. 11 This phenomenon has been correlated with abnormal indices of diastolic and systolic assessments in echocardiography. 11 Heart Rate Variability Recording the heart rate variability (HRV) by 24-hour Holter monitoring device has recently been noted as a potential method for assessment of cardiac siderosis in TDT.…”

“…11 This phenomenon has been correlated with abnormal indices of diastolic and systolic assessments in echocardiography. 11 Heart Rate Variability Recording the heart rate variability (HRV) by 24-hour Holter monitoring device has recently been noted as a potential method for assessment of cardiac siderosis in TDT. 44 A recent report showed that reduced HRV may hint the cardiac iron deposition in very early stage before being detectable by T2* MRI.…”

“…3 Iron toxicity also seems to be the main culprit in the development of cardiac fibrosis in TDT. 11 Although a relatively uncommon phenomenon, myocardial fibrosis has been reported in as high as 15%-21% of TDT patients in some studies. 12 …”

Relationship of Fragmented Wide QRS Complexes with Coronary Atherosclerosis in Patients with Left Bundle Branch Block

“…However, conditions that cause non-homogenous depolarization in the myocardium such as scarring, fibrosis and ischemia have been implied as related factors [3][4][5][6][7]. As well as coronary ischemia, cardiac infiltrative diseases such as amyloidosis and beta-thalassemia and the conditions which causes increased left ventriculer mass such as hypertension and severe aortic stenosis can lead to f-wQRS formation [23][24][25]. In a histopathological study, it has been demonstrated that coronary ischemia can also cause patch-like fibrosis without infarction [26].…”