Author/Authors :
Parsaee, Mozhgan Echocardiography Research Center - Rajaie Cardiovascular, Medical, and Research Center - Iran University of Medical Sciences, Tehran, IR Iran , Khansari, Nakisa Departement of Cardiology - Farshchian Heart Center - Hamadan University of Medical Sciences, Hamadan, IR Iran , Azarkeivan, Azita Department of Thalassemia Clinic - Transfusion Research Center - High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran , Chitsazan, Mitra Department of Thalassemia Clinic - Transfusion Research Center - High Institute for Research and Education in Transfusion Medicine, Tehran, IR Iran , Ghadrdoost, Behshid Rajaie Cardiovascular, Medical, and Research Center - Iran University of Medical Sciences, Tehran - Department of Thalassemia Clinic , Mombeini, Hoda Department of Cardiology - Khomeini Hospital - Jundishapour University of Medical Sciences, Ahvaz, IR Iran
Abstract :
Background: β-thalassemia is the most common monogenic disease caused by abnormalities in
the synthesis of the β-chain of hemoglobin.
Methods: From January 2018 to September 2018, 90 patients (age >18 y) with β-thalassemia
major or intermedia who referred to Rajaei Cardiovascular, Medical, and Research
Center, Tehran, Iran, for the assessment of myocardial iron overload were enrolled. All
the patients were receiving regular blood transfusions and chelating therapy.
Comprehensive transthoracic echocardiographic studies consisting of 2D
echocardiography, tissue Doppler imaging, and real-time 3D echocardiography were
performed.
Results: A total of 90 patients were enrolled in the study. Cardiac iron toxicity (ie, T2* < 20 ms)
was seen in 28 (31%) patients; whereas in 62 (69%) patients, the cardiac iron level was
undetectable (ie, T2* > 20 ms). Patients with T2* < 20 ms had significantly higher serum
ferritin levels than those with T2* > 20 ms (P = 0.02). No significant correlation was
found between the serum ferritin level and T2* (r = −0.08, P = 0.41). The left ventricular
ejection fraction was statistically similar in the 2D and 3D examinations. Left atrial endsystolic
and end-diastolic volumes were greater in the patients with iron cardiotoxicity
than in those with no detectable cardiac iron deposition (P = 0.01 and P <0.001,
respectively). Left atrial strain was also significantly lower in the patients with critical
iron overload. The patients with T2* < 20 ms also had lower left atrial ejection fractions
than those with T2* >20 ms, both in 2D and 3D examinations (both Ps <0.001).
Conclusions: Our study showed that changes in the left atrial structure and function precede
impairment in the left ventricular systolic function in thalassemia patients with critical
myocardial iron loading.