Tissue doppler imaging in thalassemia major patients: correlation between systolic and diastolic function with serum ferritin level

Abstract

Background Thalassemia is a major public health problem inIndonesia. Cardiac diseases remain as the main cause of death inthese patients due to iron overload. Although the T2* magneticresonance imaging has been considered as the gold standard forassessing cardiac iron overload but it has limited availability.The tissue doppler imaging (TDI) echocardiography, a fairly newand easy method that is suggested, can detect early abnormalmyocardial iron overload.Objective To assess myocardial systolic and diastolic functionof thalassemic patients using TDI and examine their correlationwith serum ferritin level.Methods A cross􀁌sectional study was conducted from January toMarch 2011 at the Harapan Kita Women and Children Hospital.We performed clinical examination, serum ferritin level, as wellas conventional and tissue doppler echocardiography on allsubjects.Results We included 34 regularly􀁌tranfused patients, of which17 were boys. The mean age of the subjects was 11.6 (SD 4.7years, range 2.6 􀁌 20 years). Mean pulse rate and blood pressurewere within normal range. Hemoglobin level at inclusion rangedfrom 5.8 to 6 g/dL. Almost all patients did not receive regularchelation therapy. Median serum ferritin level was 6275 ng/mL(range 2151 - 17,646 ng/mL). Conventional echocardiographyshowed normal systolic function, but some diastolic dysfunctionswere found including E wave abnormalites in 4 patients, A waveabnormalites in 3, and E/A ratio abnormalites found in 3. TheTDI showed decreased systolic function (Sa wave abnormality) in9 patients and diastolic dysfunctions (Ea wave abnormality in 11patients and Aa wave abnormaly in 2). No abnormality was foundin Ea/Aa and ElEa ratios. There was a weak negative correlationbetween ferritin level and Sa wave and Ea wave respectively anda moderately negative correlation between ferritin level and Ea/Aa ratio. There was no correlation between serum ferritin andAa wave or ElEa ratio.Conclusion TDI identifies a greater number of patients Mthsystolic and diastolic myocardial dysfunction than was revealedby conventional echocardiography. There was a weak negativecorrelation between serum ferritin to Sa wave and Ea wave, and amoderately negative correlation between ferritin and Ea/Aa ratio.There was no correlation between serum ferritin and Aa wave orElEa ratio. [paediatr Indones. 2012;52:187,93].

Early detection of myocardial dysfunction in poorly treated pediatric thalassemia children and adolescents: Two Saudi centers experience

“…These results are similar to other reports which also demonstrated preserved left ventricular systolic function in spite of cardiac dilatation with no significant difference between the studied cases and controls as regards the mean values of EF and FS [35] , [39] , [40] , [41] . However, other studies reported a significantly lower LVEF in thalassemia patients in comparison with healthy age and sex-matched individuals [42] , [43] .…”

“…Serum ferritin does not correlate with myocardial iron load [48] . Also, systolic dysfunction was not correlated with serum ferritin and occurred at a late stage of the disease [39] . This is why we did not correlate the echo-Doppler findings with serum ferritin levels.…”

A study of splenectomy in beta-thalassemia patients and its effects

“…According to test year data, approximately 100 Beta thalassemia patients who received more than 50 blood transfusion and serum ferritin level more than 2500 ng/ml were treated in the hospital and hence sample size of present study will be approximately 100. [11] . Thus it can be concluded that, there was an aggravating effect of splenectomy on hemosiderosis.…”