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Restrictive diastolic abnormalities identified by Doppler echocardiography in patients with thalassemia major
P Spirito1, G Lupi, C Melevendi
1Divisione di Cardiologia, Ente Ospedaliero Ospedali Galliera, Genoa, Italy.
Insights
Transfusional iron overload in thalassemia major patients impairs left ventricular diastolic filling, showing a restrictive pattern. This indicates reduced heart chamber compliance even with normal systolic function and optimal chelation therapy.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Transfusional iron overload is a common complication in thalassemia major.
- Its impact on left ventricular diastolic function remains understudied.
- Left ventricular systolic function is often preserved despite chronic iron overload.
Purpose of the Study:
- To systematically investigate left ventricular diastolic filling patterns in thalassemia major patients.
- To assess the effect of transfusional iron overload on diastolic function using Doppler echocardiography.
- To compare diastolic filling in patients with normal controls and evaluate the impact of iron chelation.
Main Methods:
- Doppler echocardiography was used to assess left ventricular diastolic filling in 32 thalassemia major patients and 32 age/sex-matched controls.
- Patients had no heart failure symptoms and normal systolic function.
- Key Doppler parameters including flow velocities, deceleration rates, and ratios were analyzed.
Main Results:
- Thalassemia major patients exhibited an abnormal "restrictive" Doppler pattern of left ventricular filling.
- Increased early diastolic peak flow velocity, increased deceleration rate, and increased early/late peak flow velocity ratio were observed.
- Reduced flow velocity deceleration time and decreased left ventricular compliance were indicated.
Conclusions:
- Transfusional iron overload leads to a restrictive pattern of left ventricular diastolic filling in thalassemia major.
- This pattern suggests impaired left ventricular compliance, even in asymptomatic patients with preserved systolic function.
- The restrictive pattern persisted even in patients receiving optimal iron chelation therapy with deferoxamine.
Abstract:
The consequences of transfusional iron overload on left ventricular diastolic filling have never been investigated systematically in patients with thalassemia major. In the present study, the pattern of left ventricular filling was assessed by Doppler echocardiography in 32 patients with thalassemia major (age, 17 +/- 5 years) who had not experienced symptoms of heart failure and had normal left ventricular systolic function. Data were compared with those obtained in 32 age-matched and sex-matched normal subjects. An abnormal Doppler pattern of left ventricular filling with increased flow velocity at mitral valve opening followed by an abrupt and premature decrease of flow velocity in early diastole was identified in the patients with thalassemia. Peak flow velocity in early diastole was increased in patients compared with controls (90 +/- 10 vs. 81 +/- 15 cm/sec; p less than 0.01), and rate of deceleration of flow velocity after the early diastolic peak and the ratio between the early and late (atrial) peaks of flow velocity were also increased (1,050 +/- 325 vs. 762 +/- 193 cm/sec2 and 2.7 +/- 0.7 vs. 2.2 +/- 0.5, respectively; p less than 0.001), whereas flow velocity deceleration time was reduced (97 +/- 22 vs. 119 +/- 19 msec; p less than 0.001). This Doppler pattern of diastolic filling is usually described as "restrictive" and reflects a decrease in left ventricular chamber compliance. A restrictive pattern of left ventricular filling was also identified in the subgroup of 16 study patients who had undergone optimal iron chelation therapy with deferoxamine.(ABSTRACT TRUNCATED AT 250 WORDS)