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Heart involvement in transfusion-dependent beta-thalassemia with conventional echocardiography
Hossein Esfahani1, Asadolah Tanasan2, Mina Rezanejad2
1Department of Pediatric Oncology, Besat Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
Insights
Conventional echocardiography reveals significant left and right heart dysfunction in transfusion-dependent beta-thalassemia patients. Right-sided heart involvement, including pulmonary hypertension, was noted, particularly in splenectomized individuals.
Area of Science:
- Cardiology
- Hematology
- Medical Imaging
Background:
- Cardiac involvement is a critical prognostic factor in transfusion-dependent beta-thalassemia.
- Echocardiography is the standard method for evaluating cardiac status in these patients.
Purpose of the Study:
- To assess myocardial and valvular heart abnormalities in transfusion-dependent beta-thalassemia using conventional echocardiography.
- To investigate the prevalence of right and left heart involvement and its correlation with clinical factors.
Main Methods:
- A cross-sectional study involving 60 transfusion-dependent beta-thalassemia patients.
- Conventional echocardiography, including transvalvular Doppler, was employed to evaluate myocardial performance and valvular function.
- Left ventricular myocardial performance index (LVMPI) and right ventricular myocardial performance index (RVMPI) were assessed.
Main Results:
- 43 out of 60 patients (71.7%) exhibited cardiac problems.
- Left myocardial dysfunction was present in 26 patients (43.3%), and right myocardial dysfunction in 11 patients (18.3%).
- Right myocardial dysfunction was associated with pulmonary hypertension (PH) in 4 patients, all of whom had undergone splenectomy. Both LVMPI and RVMPI were significantly elevated in patients with cardiac involvement (p<0.001).
- Serum ferritin levels were higher in patients with cardiac involvement (2427±1788 ng/ml) compared to those without (1573±592 ng/ml) (P=0.008).
- Splenectomized patients showed higher RVMPI (0.3±0.07 vs 0.25±0.39, P=0.004) and tricuspid regurgitation gradient (TRG) (28±11.8 mmHg vs 19.7±5.2 mmHg, P=0.033) compared to non-splenectomized patients.
Conclusions:
- Conventional echocardiography effectively identifies both left and right-sided heart involvement in transfusion-dependent beta-thalassemia.
- Right-sided heart abnormalities, including pulmonary hypertension, are prevalent and may be linked to splenectomy history.
- The correlation between serum ferritin and cardiac involvement was not significant in splenectomized patients.
Background:
The most important prognostic factor in transfusion-dependent beta-thalassemia is cardiac involvement which is usually evaluated with echocardiography.
Methods:
In this cross-sectional study (April 2011 to April 2012), conventional echocardiography was used to assess myocardial performance and valvular involvement (through transvalvular Doppler study) for right and left heart abnormalities in transfusion-dependent beta-thalassemia.
Results:
Among the 60 patients, 43 cases had heart problems, 26 (43.3%) of them had left myocardial dysfunction and 11 (18.3%) of them had right myocardial dysfunction, 3 cases had both RV and LV myocardial dysfunction, (based on LVMPI & RVMPI, respectively). In patients with right myocardial dysfunction, 4 cases had pulmonary hypertension (PH) and 3 had both sided myocardial dysfunction. LVMPI and RVMPI significantly increased in patients with cardiac involvement (p<0.001). Serum ferritin levels in patients with and without cardiac involvement were 2427±1788 ng/ml and 1573±592 ng/ml, respectively (P=0.008). All 4 patients who had PH, had been splenectomized. In splenectomized and non-splenectomized patients, LVMPI was 0.37±0.11 and 0.38±0.1 (P=0.589), RVMPI was 0.3±0.07 and 0.25±0.39 (P=0.004), and TR gradient (TRG) was 28±11.8 mmHg and 19.7±5.2 mmHg (P=0.033), respectively. Mean ferritin level in patients with a history of splenectomy (n=31), was 2525±1968 ng/ml and in patients without the history of splenectomy (n=29) was 1821±947 ng/ml (P=0.082).
Conclusion:
In addition to left-sided heart involvement, conventional echocardiography revealed right-sided heart involvement in transfusion-dependent thalassemia patients which did not correlate with serum ferritin level in splenectomized patients.
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