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Predictive echo-Doppler indices of left ventricular impairment in B-thalassemic patients

Athanassios Aessopos¹, Spyros Deftereos, Maria Tsironi

¹First Dept. of Internal Medicine, University of Athens Medical School, Laiko Hospital, Ag. Thoma 17, 11527 Athens, Greece.

Annals of Hematology

|January 31, 2007

Insights

Early detection of cardiac dysfunction in thalassemia major patients is possible using specific echocardiographic indices. Increased left ventricular end-systolic diameter (LVESD) and decreased A wave velocity are early predictors of impaired left ventricular (LV) function.

Area of Science:

Cardiology
Hematology
Medical Imaging

Background:

Thalassemia major patients require lifelong monitoring for cardiac complications.
Early detection of left ventricular (LV) dysfunction is crucial for managing cardiac damage.
Echocardiography and Doppler indices offer potential for non-invasive cardiac assessment.

Purpose of the Study:

To identify echocardiographic and Doppler indices that predict the development of LV systolic dysfunction in thalassemia major patients.
To evaluate the sensitivity and specificity of these predictive indices.

Main Methods:

Analysis of a database of 315 thalassemia major patients with 10-year cardiac follow-up.
Inclusion criteria: initial normal Shortening Fraction (SF > 30%) and recent reexamination.
Identification of patients who developed LV systolic dysfunction and comparison of echocardiographic parameters with a control group.

Main Results:

Twelve patients developed LV systolic dysfunction.
Predictive indices for LV dysfunction included higher LV end-systolic diameter (LVESD) index and lower A wave (diastolic index).
LVESD showed 97% specificity and 11% sensitivity (cutoff 2.44 cm/m²). The A wave index showed 97.7% specificity and 25% sensitivity (cutoff ≤0.36).

Conclusions:

Increased LVESD index and decreased A wave velocity are early indicators of developing LV systolic dysfunction in thalassemia major.
These parameters can serve as valuable, sensitive, and specific predictors for cardiac dysfunction in this patient population.

Read full analysis

Abstract:

Early detection of cardiac-function impairment by echo-Doppler indices can assist in preventing further cardiac damage by modifying disease progression and treatment. We analyzed our thalassemia major patients database with 10 years cardiac follow-up. Included patients were under constant therapy and should have an initial echo-Doppler study with normal Shortening Fraction (SF > 30%) and reexamination within the last year. We identified patients who developed impaired left ventricular (LV) function in the last Echo and we attempted to find which measured indices could predict LV function impairment. Three hundred fifteen of the 632 database patients were enrolled. Twelve of them developed LV systolic dysfunction. There were no statistically significant differences in mean age, ferritin, and pretransfusion hemoglobin levels of the two groups. LV-systolic-dysfunction group was presenting statistically significantly higher LF end-systolic diameter (LVESD) index, lower SF, higher early transmitral peak flow velocities/late transmitral peak flow velocities (A) ratios, lower A value. All other echocardiographic parameters did not differ significantly. By receiver-operating characteristic analysis, we determined systolic and diastolic indices specificity and sensitivity for LV impairment: LVESD 97% specificity, 11% sensitivity (cutoff value 2.44 cm/m(2) ), SF 92.1 and 33.3% (cutoff value 33%). Regarding diastolic indices, A index was the best criterion (97.7% specificity, 25% sensitivity, cutoff value

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