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Updated: Aug 23, 2025
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Effects of iron deficiency on left ventricular functions in young women regardless of anemia: A speckle tracking
Betül Cengiz Elçioğlu1, Onur Baydar1, Alparslan Kılıç1
1Department of Cardiology, Faculty of Medicine, Koç University Hospital, İstanbul, Türkiye.
Insights
Low ferritin levels, even without anemia, can impair heart function. Two-dimensional speckle tracking echocardiography reveals subclinical left ventricular dysfunction in these patients, highlighting the need for monitoring.
Area of Science:
- Cardiology
- Metabolic Disorders
- Echocardiography
Background:
- Iron deficiency is a global metabolic disorder impacting cardiovascular health.
- Iron deficiency can lead to myocardial structural and functional alterations.
Purpose of the Study:
- To assess left ventricular (LV) functions in non-anemic patients with low ferritin levels.
- Utilize two-dimensional speckle tracking echocardiography (2D STE) for evaluating LV function.
Main Methods:
- Studied 90 female participants, divided into low ferritin (<30 ng/mL) and control (>30 ng/mL) groups.
- Excluded patients with anemia, cardiovascular disease, diabetes, or infection.
- Assessed LV global longitudinal strain (GLS) and strain rate (GLSR) using 2D STE.
Main Results:
- Low ferritin group showed significantly lower LV GLS and GLSR compared to controls.
- Positive correlation found between ferritin levels and LV GLS/GLSR.
- Ferritin level < 28.5 ng/mL predicted GLS < -18% with 76.1% sensitivity and 77.3% specificity.
Conclusions:
- Low ferritin levels are associated with subclinical LV systolic dysfunction in non-anemic individuals.
- 2D STE is effective in detecting subtle LV functional changes.
- Suggests closer monitoring and potential iron replacement for patients with low ferritin.
Background:
Iron deficiency is one of the most common metabolic disorders worldwide and affects multiple organs and systems including the cardiovascular (CV) system. Iron deficiency can cause structural and functional changes in the myocardium. The aim of the study is to evaluate left ventricular (LV) functions in patients with low ferritin levels without anemia by two-dimensional "speckle tracking" echocardiography (2D STE).
Methods:
We studied 90 participants (all female) that were divided into two groups according to ferritin levels (49 patients with ferritin levels <30 ng/mL, 41 age-matched controls with >30 ng/mL). Patients with anemia (hemoglobin level <12 g/dL), known CV disease, diabetes mellitus, low ejection fraction (<55%), active infection, high ferritin levels (>200 ng/mL) were excluded. All patients were evaluated by transthoracic echocardiography. In addition to conventional echocardiographic parameters and Doppler measurements, LV global longitudinal strain (GLS) and strain rate (GLSR) were obtained by 2D STE.
Results:
Mean ferritin level was 18.96 ± 7.29 ng/mL in low ferritin group, and was 61.22 ± 26.14 ng/mL in control group. There were no significant differences according to conventional and Doppler echocardiographic parameters between the groups. LV GLS and GLSR values were significantly lower in low ferritin group comparing with control group (17.31% ± 1.56 and 18.96% ± 1.53, p < 0.001; 0.64 ± 0.13 1/s and 0.81 ± 0.13 1/s, p < 0.001, respectively). There was a significant positive correlation between ferritin levels and LV GLS and GLSR values in study group (r = 0.482, p < 0.001; r = 0.387, p < 0.001, respectively). Ferritin level was also detected as an independent risk factor for GLS value < -18% in logistic regression analysis. In ROC curve analysis, the area under the curve for predicting GLS < -18% was 0.801 (p < 0.001, 95% CI 0.70-0.89) and the threshold of ferritin value was 28.5 ng/mL (sensitivity 76.1%, specificity 77.3%).
Discussion:
Low ferritin levels can cause subclinical LV systolic dysfunction in patients without anemia. STE provides detailed information about LV functions. With larger studies, these patients should be followed more closely and considered for iron replacement treatment before developing anemia.
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