Related Experiment Video
Updated: May 19, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Left ventricular rotational dynamics in Beta thalassemia major: a speckle-tracking echocardiographic study
Ines Monte1, Sergio Buccheri, Vera Bottari
1Scienze Mediche e Pediatriche Department, University of Catania, Catania, Italy. inemonte@unict.it
Insights
Early detection of cardiac dysfunction in thalassemia major (TM) is crucial. New left ventricular (LV) rotational dynamics parameters can identify subclinical cardiac involvement related to iron overload in asymptomatic TM patients.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Iron-mediated cardiomyopathy is a primary cause of mortality in thalassemia major (TM).
- Early identification of cardiac dysfunction is vital for optimizing treatment in TM patients.
- Subclinical cardiac involvement necessitates advanced diagnostic markers.
Purpose of the Study:
- To identify early markers of cardiac dysfunction using novel left ventricular (LV) rotational dynamics parameters.
- To investigate the relationship between these rotational parameters and indicators of iron overload in TM.
- To assess the utility of LV rotational dynamics for early diagnosis of cardiac involvement in TM.
Main Methods:
- Prospective enrollment of 27 asymptomatic TM patients and 27 healthy controls.
- Standard echocardiography with offline speckle-tracking analysis for LV rotation and longitudinal mechanics.
- Measurement of serum ferritin levels and cardiac magnetic resonance imaging (T2* values) in TM patients.
Main Results:
- TM patients exhibited significantly reduced LV rotational parameters, including twist and torsion, despite normal standard cardiac function.
- Reduced LV rotational function correlated with increased iron overload, indicated by lower T2* values and higher ferritin levels.
- LV torsion was negatively associated with ferritin levels and positively with T2* values, highlighting iron's detrimental effect.
Conclusions:
- Left ventricular rotational dynamics are significantly impaired in asymptomatic TM patients due to iron overload.
- Normal T2* values indicate preserved LV rotational function, suggesting a threshold for iron-induced damage.
- Novel LV rotational parameters serve as valuable tools for early detection of cardiac involvement in TM.
Background:
Iron-mediated cardiomyopathy is the leading cause of death in patients with thalassemia major (TM). The identification of subclinical cardiac involvement in the early phases of the disease is important to optimize therapeutic strategies. The aim of this study was to identify early markers of cardiac dysfunction through new parameters of cardiac rotational dynamics and to look for a relationship with parameters of iron overload.
Methods:
Twenty-seven asymptomatic patients with TM and 27 healthy control subjects were prospectively enrolled. All subjects underwent standard echocardiography and subsequent offline analysis to assess left ventricular (LV) rotation and longitudinal mechanics using speckle-tracking echocardiography. In all patients with TM, ferritin levels were measured, and a subgroup underwent cardiac magnetic resonance imaging.
Results:
All subjects had normal parameters of cardiac function, although patients with TM showed significantly lower S' values (P = .030) and E' values (P = .025), with increased E/E' ratio (P = .003) and indexed left atrial volumes (P = .022). Compared with controls, patients with TM had significantly reduced systolic apical rotation (P = .006), LV twist (P = .002), and LV torsion (P = .001). Systolic and diastolic rotational peak velocities at the apical level were also significantly decreased in the TM group (P = .003 and P = .011, respectively) with reductions of twisting and untwisting rates (P = .003 and P = .001, respectively). Patients with TM also showed a significant reduction of longitudinal displacement from the two-chamber apical view (P = .042) but preserved longitudinal strain and strain rate. Patients with T2* values > 20 msec had preserved rotational function, while those with T2* values < 20 msec showed significantly lower mean values of LV peak basal systolic rotation (-3.1 ± 1.4° vs -6.2 ± 2.6°, P = .016), LV peak apical systolic rotation (3.4 ± 1.3° vs 6.4 ± 3.1°, P = .045), LV twist (4.8 ± 2.5° vs 10.9 ± 4.9°, P = .012), and LV torsion (0.6 ± 0.2°/cm vs 1.4 ± 1.6°/cm, P = .010). LV torsion was negatively related to ferritin levels (r = -0.47, P = .013) and directly to T2* values (r = 0.64, P = .007).
Conclusions:
LV rotational dynamics in asymptomatic patients with TM are negatively related to iron overload. Rotational function of the left ventricle is preserved in patients with normal T2* values. These new parameters are useful for an early diagnosis of cardiac involvement.
