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Updated: May 7, 2026
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Assessment of left ventricular and atrial diastolic function using two-dimensional (2D) strain imaging in patients
Alexandra G Karamanou1, Eftihia S Hamodraka, Spyridon C Vrakas
1University of Athens Medical School, Athens, Greece.
Insights
New echocardiography markers detect latent diastolic dysfunction in β-thalassemia major patients earlier than traditional methods. These advanced echo indexes offer better prognostic value for identifying early cardiac issues in this population.
Area of Science:
- Cardiology
- Medical Imaging
- Hematology
Background:
- β-thalassemia major is characterized by early diastolic dysfunction due to iron overload.
- Left ventricular systolic dysfunction in this condition is multifactorial.
Purpose of the Study:
- To investigate left ventricular diastolic dysfunction in β-thalassemia major using novel speckle tracking echocardiography indices.
- To compare the efficacy of new echo indices against conventional methods for assessing diastolic function.
Main Methods:
- Eighty-eight patients with β-thalassemia major and preserved ejection fraction were studied.
- Patients were categorized based on the E/E' ratio to define diastolic function status.
- Tissue Doppler echocardiography and 2D strain imaging were employed, alongside plasma BNP measurements.
Main Results:
- Patients with diastolic dysfunction exhibited significantly higher left atrial volumes and indices.
- Radial and peak atrial 2D strain were significantly reduced in patients with diastolic dysfunction.
- Peak atrial 2D strain demonstrated high accuracy (90% sensitivity, 81% specificity) in identifying diastolic dysfunction.
Conclusions:
- β-thalassemia major patients with preserved systolic function show impaired atrial and ventricular function.
- Novel echocardiographic markers are more effective than traditional indices for early detection of diastolic dysfunction in β-thalassemia major.
- These new markers can identify latent diastolic dysfunction earlier than the E/E' ratio.
Background:
β-thalassemia major is a unique disease characterized by early severe diastolic dysfunction, due to iron myocardial deposition alone, while left ventricular systolic dysfunction and failure seem to be multifactorial in aitiology.
Objectives:
The purpose of this study was to investigate left ventricular diastolic dysfunction using a new echo index as speckle tracking in comparison with the conventional methods.
Material And Methods:
Eighty-eight consecutive patients (38 male, 50 female) aged 36 ± 8.2 yr with β-thalassemia major and preserved LV ejection fraction (LVEF>55%) were studied. Patients were divided into two groups according to the E mitral/E mitral annulus ratio (E/E'): group A patients with E/E' ratio ≤8 and group B patients with E/E' >8. Cutoff value of eight was used to separate patients with normal and abnormal diastolic function. All subjects were studied thoroughly by tissue Doppler echocardiography as also by 2D left ventricular and atrial strain imaging 2-4 d following blood transfusion. Blood samples were also taken for plasma BNP measurements at the same time.
Results:
Left atrial volumes(LAV max, LAV min) as also left atrial index were significantly higher in patients with diastolic dysfunction compared with patients without diastolic dysfunction(LAV max: 57.6 ± 19.4 vs. 71.3 ± 22.9, P < 0.01,LAV min: 20.2 ± 11.4 vs. 33.9 ± 18, P < 0.01, LAVI: 37.66 ± 12.18 vs. 47.13 ± 14.77, P < 0.01). Radial 2D strain (RS) and peak atrial 2D strain (AS) were significantly reduced in patients with suspected diastolic dysfunction compared with patients without diastolic dysfunction (RS: 43.48 ± 13.92 vs. 35.58 ± 11.32, P < 0.05; AS: 36.36 ± 8.45 vs. 29.85 ± 9.25, P < 0.01). Using ROC analysis, peak atrial 2D strain at a cutoff of 41.1 cm/s was highly accurate (AUC: 0.66, P < 0.05 in ruling out diastolic dysfunction (E/E'<8) with a sensitivity of 90% and a specificity of 81%.
Conclusions:
B-thalassemic major patients with preserved left ventricular systolic function had impaired left atrial function at the longitudinal axis and left ventricular function at the radial axis. The new echo markers have better prognostic value than the traditional echo indexes in detecting latent diastolic dysfunction in β-thalassemia major, earlier than E/E' ratio.
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