Related Experiment Videos
Value of speckle tracking echocardiography for detection of clinically silent left ventricular dysfunction in
Mozhgan Parsaee1, Sedigheh Saedi2, Pegah Joghataei3
1a Echocardiography Research Center, Rajaei Cardiovascular , Medical and Research Center , Tehran , Iran.
Insights
β-Thalassemia patients show reduced global longitudinal strain (GLS) on echocardiography, indicating early cardiac dysfunction. This method detects subclinical myocardial issues, independent of iron levels, aiding early intervention for this inherited blood disorder.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- β-Thalassemia is an inherited disorder causing chronic anemia and requiring transfusions.
- Cardiac complications are the primary cause of mortality in thalassemia major patients.
- Early detection of subclinical left ventricular dysfunction is crucial due to the narrow margin between normal and impaired function.
Purpose of the Study:
- To identify a novel, simple echocardiographic parameter for early detection of cardiac involvement in β-thalassemia.
- To evaluate the utility of speckle tracking echocardiography in assessing subclinical myocardial dysfunction.
- To explore the relationship between cardiac iron load and myocardial strain.
Main Methods:
- Prospective study of 55 β-thalassemia major patients on transfusion and chelation therapy.
- Measurements included ferritin, cardiac magnetic resonance (CMR) T2*, conventional echocardiography, and speckle tracking analysis (LV strain and time-to-peak strain).
- Comparison of strain values with a normal control group.
Main Results:
- Significant reduction in global longitudinal strain (GLS) and basal segments longitudinal strain in thalassemia patients compared to controls.
- No significant difference in circumferential strain between groups.
- No significant correlation found between GLS and CMR T2* values, indicating independence from cardiac iron load.
Conclusions:
- Speckle tracking echocardiography, specifically GLS, is a feasible method for evaluating subclinical myocardial dysfunction in thalassemia major.
- GLS can predict silent myocardial dysfunction independently of iron deposition (CMR T2*).
- Chronic anemia-induced hypoxia may initiate cardiac injury, with iron deposition exacerbating it; speckle tracking detects these early changes.
Objective:
β-Thalassemia is an inherited hemoglobin disorder resulting in chronic hemolytic anemia requiring chronic transfusion therapy. Cardiac involvement is the main cause of death in patients with thalassemia major. The narrow border is between overt myocardial dysfunction and clinically silent left ventricular (LV) dysfunction in patients with thalassemia. Therefore, we need novel parameters in different imaging techniques to discover cardiac involvement in an early and subtle stage. We explore to find a novel, straightforward and informative parameter in echocardiography as a noninvasive, economical and really routine in clinical practice.
Methods:
In this prospective study, 55 patients, who are known cases of β-thalassemia major, receiving long-term blood transfusions and undergoing iron chelation therapy were enrolled. Ferritin level, cardiac magnetic resonance (CMR) T2 * value, full conventional echocardiography and speckle tracking, LV regional circumferential and longitudinal strain values (%) and time-to-peak strain (ms) of 17 segments cardiac model in eyeball tomogram were measured.
Results:
There was a significant reduction in global longitudinal strain (GLS) (-20.9% ± 1.9 vs. -22.2 ± 1.03) and also basal segments longitudinal strain compared to normal subjects group (-17.4% ± 2.7 vs. -19.6% ± 1.2). There was no significant difference in circumferential strain value between thalassemia patients and normal control group. Interestingly, there was no significant correlation between GLS and CMR T2 * values showing no association between cardiac iron load and longitudinal strain.
Conclusion:
Speckle tracking echocardiography could be used as a feasible method for evaluating subclinical myocardial dysfunction in patients with thalassemia major. Echocardiography, using GLS, could predict clinically silent myocardial dysfunction independent of CMR (T2 * value) and extension of iron deposition. Our study also puts forward other causes such as chronic tissue hypoxia resulting from chronic anemia as a root cause and initiating factor for subsequent injury by the iron deposition. Speckle tracking can recognize the cardiac involvement in really early stages.