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Published on: June 5, 2019
Heart Rate Variability as an Alternative Indicator for Identifying Cardiac Iron Status in Non-Transfusion Dependent
Karn Wijarnpreecha1, Natthaphat Siri-Angkul1, Krekwit Shinlapawittayatorn1
1Cardiac Electrophysiology Research and Training Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Cardiac Electrophysiology Unit, Department of Physiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Center of Excellence in Cardiac Electrophysiology, Chiang Mai University, Chiang Mai, Thailand.
Insights
Heart rate variability (HRV) can detect early cardiac iron in thalassemia patients, serving as a potential alternative to cardiac magnetic resonance (CMR) T2*. This non-invasive method aids in identifying iron overload before heart dysfunction occurs.
Area of Science:
- Cardiology
- Hematology
- Biomedical Engineering
Background:
- Iron-overload cardiomyopathy is a leading cause of mortality in thalassemia patients.
- Early detection of cardiac iron accumulation is crucial but limited by the availability of cardiac magnetic resonance (CMR) T2*.
- Heart rate variability (HRV) is known to reflect cardiac autonomic function and is often depressed in thalassemia.
Purpose of the Study:
- To investigate the potential of HRV as an alternative, non-invasive indicator for early detection of cardiac iron deposition in thalassemia.
- To establish a direct correlation between HRV parameters and markers of iron overload, including non-transferrin bound iron (NTBI) and CMR-T2*.
Main Methods:
- Ninety-nine non-transfusion dependent thalassemia patients were enrolled.
- Twenty-four-hour Holter monitoring was used to record HRV.
- Correlations were analyzed between HRV, NTBI, hemoglobin (Hb), serum ferritin, LV ejection fraction (LVEF), and CMR-T2*.
Main Results:
- Both time and frequency domains of HRV significantly correlated with NTBI levels.
- The LF/HF ratio of HRV showed a significant correlation with CMR-T2* (ROC curve 0.684±0.063), suggesting its utility in assessing cardiac iron deposits.
- HRV also demonstrated significant correlations with serum ferritin and Hb levels.
Conclusions:
- HRV is a potential non-invasive marker for identifying early cardiac iron deposition in thalassemia patients.
- HRV may serve as a viable alternative to CMR-T2* for screening cardiac iron status, particularly before the onset of left ventricular dysfunction.
Background:
Iron-overload cardiomyopathy is a major cause of death in thalassemia patients due to the lack of an early detection strategy. Although cardiac magnetic resonance (CMR) T2* is used for early detection of cardiac iron accumulation, its availability is limited. Heart rate variability (HRV) has been used to evaluate cardiac autonomic function and found to be depressed in thalassemia. However, its direct correlation with cardiac iron accumulation has never been investigated. We investigated whether HRV can be used as an alternative indicator for early identification of cardiac iron deposition in thalassemia patients.
Methods:
Ninety-nine non-transfusion dependent thalassemia patients (23.00 (17.00, 32.75) years, 35 male) were enrolled. The correlation between HRV recorded using 24-hour Holter monitoring and non-transferrin bound iron (NTBI), hemoglobin (Hb), serum ferritin, LV ejection fraction (LVEF), and CMR-T2* were determined.
Results:
The median NTBI value was 3.15 (1.11, 6.59) μM. Both time and frequency domains of HRV showed a significant correlation with the NTBI level, supporting HRV as a marker of iron overload. Moreover, the LF/HF ratio showed a significant correlation with CMR-T2* with the receiver operating characteristic (ROC) curve of 0.684±0.063, suggesting that it could represent the cardiac iron deposit in thalassemia patients. HRV was also significantly correlated with serum ferritin and Hb.
Conclusions:
This novel finding regarding the correlation between HRV and CMR-T2* indicates that HRV could be a potential marker in identifying early cardiac iron deposition prior to the development of LV dysfunction, and may be used as an alternative to CMR-T2* for screening cardiac iron status in thalassemia patients.
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